A Preliminary Look at Use of PE and CPT in VHA Specialty Outpatient PTSD Programs

Sayer NA, Rosen CS, Nugent S, Kehle-Forbes SM, Chard K, Bernardy NC, Schnurr P, Orazem R, Mohr D. A Preliminary Look at Use of PE and CPT in VHA Specialty Outpatient PTSD Programs. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.

Related HSR&D Project(s)

• CDA 09-020 – Dissemination & Implementation of Exposure Treatments for PTSD
• DHI 07-150 – Soldier to Civilian: RCT of an Intervention to Promote Post-Deployment Reintegration
• IIR 10-314 – Spatiotemporal Spread of Newer Antipsychotics for Bipolar Disorder and PTSD
• CRE 12-021 – Promoting Effective, Routine, and Sustained Implementation of Stress Treatments (PERSIST)

Objectives: To provide preliminary data across specialty outpatient PTSD programs (SOPPs) on: (a) use of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), the two evidence-based psychotherapies for PTSD VHA has rolled out; and (b) regional variation in use of CPT and PE. Methods: The Evidence-Based Psychotherapy CREATE study, PERSIST, required identification of outpatient PTSD teams that vary in use of PE and CPT. This study is based on the chart note data collected to quantify use of PE and CPT for the parent study. We extracted 1,002,721 psychotherapy chart notes for Veterans with PTSD who received individual or group psychotherapy in a SOPP over an 18 month period (4/ 2011-10/2012). We used SAS software for statistical text mining to identify use or discussion of PE and/or CPT. Data were aggregated up to the parent facility within VISN and nested into four US census regions: Northeast, Midwest, South, West. Results: 110,491 unique patients received group or individual psychotherapy for PTSD in a SOPP. Almost 20% of these Veterans received or discussed PE and/or CPT. The overall rate of CPT was twice the overall rate of PE (15% vs 7%). This pattern held across VISNs. There was a four-fold difference in PE and/or CPT use in SOPPS across VISNs (7% to 29%). PE and/or CPT use within SOPPs was even more variable across facilities, ranging from < 1% to 50%. The rate of PE and/or CPT was lower in the SOPPs in the Northeast (13%) compared with those in other US regions, which were largely comparable (20%-22%) and did not differ by facility urban/rural status. Number of SOPP providers who completed VHA training in PE and/or CPT was not related to rate of use of these evidence-based psychotherapies. Implications: Findings indicate considerable variability across facilities and VISNs in use of PE and CPT across SOPPs. Reasons for variation and less widespread use of PE warrant further study. Impacts: In-depth study of high performing SOPPs may identify practices to reduce unwanted variation and augment use of PE and CPT.