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 At least 500,000 veterans in the Veterans Health Administration (VHA)
system, or nearly 10 percent of the VHA population, were diagnosed
with PTSD in 2012, the researchers write in JAMA Psychiatry.
Previous studies have found that PTSD treatments delivered by
interactive video are equivalent to therapy given in person,
according to lead author John Fortney of the VA Puget Sound Health
Care System in Seattle, Washington.
“PTSD services are available to all Veterans enrolled in the VA, but
each veteran’s perceptions about their access to care can depend on
many factors,” Fortney told Reuters Health by email.
“We know that 38 percent of VA patients diagnosed with PTSD live in
rural areas, and that two thirds live closer to one of VA’s 825
Community Based Outpatient Clinics than to a large Medical Center (VAMC),
which underscores the importance of striving to provide the highest
quality PTSD care in these clinics,” he said.
For the new study, researchers included 265 middle-aged vets with
severe PTSD symptoms at one of the outpatient clinics without onsite
psychiatrists or psychologists from 2009 through 2011. Patients were
recruited from Shreveport, Louisiana, Little Rock, Arkansas and Loma
Linda, California.
Half received the outpatient clinic’s ordinary care, and the other
half were connected to an additional care team at a larger medical
center via telemedicine, including nursing care managers and
pharmacists calling their homes and psychiatrists providing
consultations by video-chat at the outpatient clinic. The
psychiatrists then gave feedback and treatment recommendations to
providers at the clinic through electronic medical records.
Psychologists delivered cognitive processing therapy, a specific
behavioral therapy developed to treat PTSD, by video chat.
During the study, more than half of the telemedicine group received
cognitive processing therapy, compared to 12 percent of the
comparison group.
Patients in the telemedicine group had bigger decreases in
Posttraumatic Diagnostic Scale scores at the six and 12-month mark
than the comparison group, according to the authors.
There was no difference in medicines prescribed or taken between the
two groups, the authors write.
“Dr. Fortney’s intervention developed a method to extend the reach
of the specialized PTSD services to the community primary care
clinics by using telehealth technology,” said Michele Spoont, Health
Psychologist in the Minneapolis VA Health Care System and assistant
professor in the Departments of Psychiatry and Psychology at the
University of Minnesota.
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“Not only does it make it easier for veterans to get the specialized
treatments, but maybe it will help those veterans who are hesitant
to go to a mental health program get evidence-based PTSD treatment
if it is offered in a primary care setting,” Spoont told Reuters
Health by email.
She was not involved in the new research.
Veterans should seek mental health care if they experience
irritability or anger problems, depression, anxiety, insomnia,
nightmares or unwanted memories about traumatic experiences, or if
they’re self-medicating with alcohol or drugs, having difficulty
doing normal day-to-day activities because of emotional problems or
difficulty concentrating, uncharacteristic conflict with family or
friends, or having suicidal or violent thoughts or impulses, Spoont
said.
“Any VA primary care provider can help them get connected with
mental health services,” she said. “They can also call their local
VA or go on the VA website to find locations near them for access to
mental health services.” (http://www.va.gov/)
Not all patients are comfortable with interactive video technology,
but the vast majority of patients are highly satisfied receiving
psychiatric and psychological services via interactive video,
Fortney said.
“Many components of the telemedicine-based collaborative care model
are currently available in the VA, including care manager programs,
telepsychiatry, and in person Cognitive Processing Therapy,” Fortney
said. “However, it is not common to see the delivery of Cognitive
Processing Therapy combined with the other components of the
telemedicine-based collaborative care model.”
It would be feasible to implement this telemedicine strategy in the
VA, but more research first needs to identify the strategies that
would need to be put into place in order to promote the widespread
adoption of this particular model of care, he said.
SOURCE: http://bit.ly/15ep4dD JAMA Psychiatry, November 19, 2014.
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