Telemedicine Outreach for Post Traumatic Stress in CBOCs
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/10/2019 |
| Start Date: | November 2009 |
| End Date: | September 2013 |
The purpose of this study is improved outcomes for veterans with Post Traumatic Stress
Disorder (PTSD) treated in small VA Community Based Outpatient Clinics (CBOCs). Although
psychotherapy and pharmacotherapy treatments for PTSD have been proven to be efficacious in
controlled trials, geographic barriers often prevent veterans from accessing these
evidence-based treatments. Telemedicine technologies will be used to overcome geographic
barriers to care. Specifically, we will evaluate the Telemedicine Outreach for PTSD (TOP)
intervention which is based on the principals of the Chronic Care Model and Disease
Management, and builds on the evidence base of quality improvement for depression in primary
care settings. The TOP intervention will employ an off-site PTSD care team
(tele-psychiatrist, tele-psychologist, tele-pharmacist, and tele-nurse care manager) and will
use telemedicine technologies (telephone, interactive video and electronically shared medical
records) to treat CBOC patients with a newly emerging or chronic PTSD. We hypothesize that
study participants randomized to the TOP intervention will receive higher quality of care and
experience better outcomes compared to study participants randomized to treatment as usual.
Disorder (PTSD) treated in small VA Community Based Outpatient Clinics (CBOCs). Although
psychotherapy and pharmacotherapy treatments for PTSD have been proven to be efficacious in
controlled trials, geographic barriers often prevent veterans from accessing these
evidence-based treatments. Telemedicine technologies will be used to overcome geographic
barriers to care. Specifically, we will evaluate the Telemedicine Outreach for PTSD (TOP)
intervention which is based on the principals of the Chronic Care Model and Disease
Management, and builds on the evidence base of quality improvement for depression in primary
care settings. The TOP intervention will employ an off-site PTSD care team
(tele-psychiatrist, tele-psychologist, tele-pharmacist, and tele-nurse care manager) and will
use telemedicine technologies (telephone, interactive video and electronically shared medical
records) to treat CBOC patients with a newly emerging or chronic PTSD. We hypothesize that
study participants randomized to the TOP intervention will receive higher quality of care and
experience better outcomes compared to study participants randomized to treatment as usual.
Approximately 400 Veterans with PTSD will be recruited from nine CBOCs in VISN 16 and 22.
Veterans screening positive for PTSD and those already in active treatment will be recruited.
Patients actively engaged in specialty PTSD treatment at the parent VAMC will be excluded.
Patients will be the unit of randomization. A dedicated nurse telephone care manager will
educate/activate patients, identify treatment preferences, overcome treatment barriers,
monitor symptoms, side-effects and adherence, identify psychiatric comorbidities, and
encourage patient self-management. Tele-pharmacists will provide medication management by
phone. Tele-psychologists will provide Cognitive Processing Therapy (without exposure) via
interactive video. Tele-psychiatrists will supervise the off-site care team as well as
conduct consultations and provide medication management via interactive video. Telephone
interviews will be administered at baseline, six and twelve months by blinded research
assistants. Process of care measures will include: 1) whether the veteran received a
documented treatment concordant with VA/DoD PTSD Treatment Guidelines, 2) self-reported
adherence to treatment, and 3) satisfaction with care as measured by Experience of Care and
Health Outcomes (ECHO) Survey. Clinical outcomes will include: 1) PTSD severity as measured
by the Posttraumatic Diagnostic Scale (PDS), 2) depression severity as measured by the PHQ9,
3) quantity and frequency of alcohol consumption, 4) health status as measured by the SF12V
and 5) quality of life as measured by the Quality of Well-Being (QWB) scale. Activity based
costing methods will be used to measure intervention cost data.
Veterans screening positive for PTSD and those already in active treatment will be recruited.
Patients actively engaged in specialty PTSD treatment at the parent VAMC will be excluded.
Patients will be the unit of randomization. A dedicated nurse telephone care manager will
educate/activate patients, identify treatment preferences, overcome treatment barriers,
monitor symptoms, side-effects and adherence, identify psychiatric comorbidities, and
encourage patient self-management. Tele-pharmacists will provide medication management by
phone. Tele-psychologists will provide Cognitive Processing Therapy (without exposure) via
interactive video. Tele-psychiatrists will supervise the off-site care team as well as
conduct consultations and provide medication management via interactive video. Telephone
interviews will be administered at baseline, six and twelve months by blinded research
assistants. Process of care measures will include: 1) whether the veteran received a
documented treatment concordant with VA/DoD PTSD Treatment Guidelines, 2) self-reported
adherence to treatment, and 3) satisfaction with care as measured by Experience of Care and
Health Outcomes (ECHO) Survey. Clinical outcomes will include: 1) PTSD severity as measured
by the Posttraumatic Diagnostic Scale (PDS), 2) depression severity as measured by the PHQ9,
3) quantity and frequency of alcohol consumption, 4) health status as measured by the SF12V
and 5) quality of life as measured by the Quality of Well-Being (QWB) scale. Activity based
costing methods will be used to measure intervention cost data.
Inclusion Criteria:
- diagnostic Criteria for PTSD (CAPS),
- veterans,
- treated in CBOC
Exclusion Criteria:
- schizophrenia,
- bipolar disorder,
- current substance dependence,
- current specialty PTSD treatment at VA Medical Center,
- no access to telephone,
- hearing or speech impediment,
- terminal illness,
- non-capacity to consent
We found this trial at
3
sites
Click here to add this to my saved trials
Click here to add this to my saved trials
Click here to add this to my saved trials