Telemed J E Health - A pilot trial of telephone-based collaborative care management for PTSD among Iraq/Afghanistan war veterans.

Tópicos

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Resumo

CKGROUND: Collaborative care and care management are cornerstones of Primary Care-Mental Health Integration (PC-MHI) and have been shown to reduce depressive symptoms. Historically, the standard of Veterans Affairs (VA) collaborative care was referring patients with posttraumatic stress disorder (PTSD) to specialty care. Although referral to evidence-based specialty care is ideal, many veterans with PTSD do not receive such care. To address this issue and reduce barriers to care, VA currently recommends veterans with PTSD be offered treatment within PC-MHI as an alternative. The current project outlines a pilot implementation of an established telephone-based collaborative care model-Translating Initiatives for Depression into Effective Solutions (TIDES)-adapted for Iraq/Afghanistan War veterans with PTSD symptoms (TIDES/PTSD) seen in a postdeployment primary care clinic.MATERIALS AND METHODS: Structured medical record extraction and qualitative data collection procedures were used to evaluate acceptability, feasibility, and outcomes.RESULTS: Most participants (n=17) were male (94.1%) and white (70.6%). Average age was 31.2 (standard deviation=6.4) years. TIDES/PTSD was successfully implemented within PC-MHI and was acceptable to patients and staff. Additionally, the total number of care manager calls was positively correlated with number of psychiatry visits (r=0.63, p<0.05) and amount of reduction in PTSD symptoms (r=0.66, p<0.05). Overall, participants in the pilot reported a significant reduction in PTSD symptoms over the course of the treatment (t=2.87, p=0.01).CONCLUSIONS: TIDES can be successfully adapted and implemented for use among Iraq/Afghanistan veterans with PTSD. Further work is needed to test the effectiveness and implementation of this model in other sites and among veterans of other eras.

Resumo Limpo

ckground collabor care care manag cornerston primari carement health integr pcmhi shown reduc depress symptom histor standard veteran affair va collabor care refer patient posttraumat stress disord ptsd specialti care although referr evidencebas specialti care ideal mani veteran ptsd receiv care address issu reduc barrier care va current recommend veteran ptsd offer treatment within pcmhi altern current project outlin pilot implement establish telephonebas collabor care modeltransl initi depress effect solut tidesadapt iraqafghanistan war veteran ptsd symptom tidesptsd seen postdeploy primari care clinicmateri method structur medic record extract qualit data collect procedur use evalu accept feasibl outcomesresult particip n male white averag age standard deviat year tidesptsd success implement within pcmhi accept patient staff addit total number care manag call posit correl number psychiatri visit r p amount reduct ptsd symptom r p overal particip pilot report signific reduct ptsd symptom cours treatment t pconclus tide can success adapt implement use among iraqafghanistan veteran ptsd work need test effect implement model site among veteran era

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