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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1020 — Outcomes of Telephone Case Monitoring for Veterans with PTSD

Rosen CS, NCPTSD & CHCE - Palo Alto; Tiet QQ, CHCE & NCPTSD - Palo Alto; Harris AH, CHCE - Palo Alto; Julian T, VA Western NY HCS; Kennedy A, VA Puget Sound HCS; Moore WM, North Little Rock VAMC; Owen RR, CeMHOR - North Little Rock; Rogers S, Coatesville VAMC; Schnurr PP, NCPTSD - White River Junction; Smith DE, VA Puget Sound HCS

Objectives:
Veterans' treatment gains during residential PTSD treatment are often not fully maintained after discharge. The purpose of this randomized controlled trial was to test whether a telephone care management intervention could facilitate Veterans' engagement in outpatient aftercare and thereby improve PTSD, violence, substance use, and re-hospitalization outcomes in the year after discharge from residential PTSD treatment.

Methods:
Veterans recruited from five PTSD residential treatment programs (n = 837) were randomly assigned to either usual aftercare (n = 425) or usual aftercare augmented by up to 6 biweekly telephone care management calls in the first 3 months after discharge (n = 412). Telephone case monitors assessed Veterans’ functioning and treatment compliance, provided encouragement and problem-solving support, and alerted providers to emergent needs. Patients’ clinical outcomes were assessed via mail surveys roughly 4 and 12 months post-discharge. Outpatient and inpatient treatment utilization were determined from VA administrative data. Outcomes across conditions were compared using survival analysis and mixed-effects regression.

Results:
Telephone case monitors were successful in contacting 89% of patients in the intervention condition, completing an average of 4 out of 6 planned telephone calls (average length of calls was 17 minutes). There were no significant differences between conditions in patient-reported PTSD, violence, substance use problems, depression, or quality of life outcomes in the year after discharge from residential treatment. Patients in the two conditions also did not differ in one-year re-hospitalization rates (11% for intervention vs. 13% for control condition), completion of an outpatient visit within 30 days of discharge (86% vs. 87%), or in total outpatient mental health visits in the year after discharge (median = 19 vs. 18, bottom 25th percentile = 8 in both conditions).

Implications:
Telephone case monitoring did not improve Veterans' outpatient treatment engagement or clinical outcomes after they discharged from residential treatment. Results suggest reasonably good retention in aftercare in both study conditions. Nonetheless, many patients experienced some rebound in PTSD symptoms after leaving residential treatment.

Impacts:
Telephone care management has been shown to be effective in improving mental health outcomes in primary care, where treatment contacts are usually infrequent and patients are relatively high-functioning. However, telephone care management does not appear to be effective in improving mental health outcomes of more severely impaired Veterans who already receive a fair amount of outpatient services.


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