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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1090 — Telemedicine versus Face-to-Face Patient Care: A Comparison of Treatment Avoidance in Post-Traumatic Stress Disorder (PTSD) Patients

Zuest DK (HSR&D VA San Diego), Agha Z (HSR&D VA San Diego), Floto E (Veterans Medical Research Foundation), Fidler J (Veterans Medical Research Foundation), Moreno L (HSR&D VA San Diego), Barsotti R (Veterans Medical Research Foundation), Repp A (Veterans Medical Research Foundation), Ross B (Veterans Medical Research Foundation), Zamora T (HSR&D VA San Diego), Thorp S (HSR&D VA San Diego)

Objectives:
Telemedicine is being studied as a possible method of delivering treatment for PTSD. Telemedicine offers access to care for veterans who do not live close to healthcare facilities that provide PTSD therapy. The study objective was to conduct a comparison of treatment adherence for telemedicine and in-person treatment modalities.

Methods:
An ongoing PTSD study is providing 12 sessions of manualized prolonged exposure psychotherapy to San Diego Veterans via telemedicine or in-person modality. Half of the participants are randomly assigned to see a therapist in-person at the La Jolla VA Medical Center and the other half may choose one of three community-based outpatient clinics in which to receive therapy via telemedicine. Missed appointment history from preliminary data (N = 62) was analyzed to determine if there is a difference between the number of cancellations (patient called to cancel prior to start of session) and no shows for telemedicine versus in-person patients.

Results:
Patients who received therapy via telemedicine had fewer cancellations (24% vs. 34%) and no shows (5% vs. 19%) than patients who received therapy in-person. These results include several cases where patients missed a session multiple times. The number of patients that dropped out of treatment was higher for in-person (29%) than telemedicine (6%). A qualitative comparison of reasons for therapy appointment cancellations/no shows for telemedicine and in-person treatment modalities will be discussed. Knowledge on reasons why PTSD patients miss therapy appointments will help in understanding treatment success.

Implications:
The best predictor of PTSD treatment success is consistent therapy attendance. Telemedicine patients missed fewer appointments than in-person patients. Telemedicine may not only be physically convenient, but may be emotionally convenient for avoidant patients. Tele-mediated communication between patient and provider allows for self-expression and disclosure of emotionally difficult information since the patient may perceive the telemedicine modality as an anonymity mask, removing fear of social rejection. Telemedicine seems to empower the patient to seek more information from the provider since they feel less intimidated than during in-person interactions.

Impacts:
The use of telemedicine not only extends effective, specialized treatment for PTSD to veterans with poor access to care, the current study provides evidence for increased treatment adherence.


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