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2015 HSR&D/QUERI National Conference Abstract

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3008 — Developing a PTSD pharmacotherapy provider support tool for CPRS

Spoont MR, COIN: Center for Chronic Disease Outcomes Research (CCDOR); NCPTSD; Bass DL, University of Minnesota; Friedman MJ, NCPTSD; Felker BL, Center of Innovation for Veteran-Centered and Value-Driven Care;

Objectives:
VA/DoD clinical practice guidelines (CPG) recommend SSRIs and SNRIs as first line treatments for PTSD. OMHS policy requires PTSD pharmacotherapy to be available in all CBOCs. As part of the PTSD CREATE, this project addresses the limited availability of psychiatrists in some CBOCs by training and supporting primary care providers (PCP) to provide PTSD pharmacotherapy. To support the PCPs in this endeavor, we sought to make the PTSD CPG pharmacotherapy information available for PCPs at the point of care in CPRS. However, many CPGs, like those for PTSD, are structured as recommendations. To facilitate adoption of the PTSD CPGs by PCPs, such recommendations needed to be translated into practice points that could also be adapted to individual patients.

Methods:
To develop a provider support tool that was acceptable to psychiatrists with different practice styles and that also met the needs of primary care providers with varying comfort treating mental illness, we conducted a step-wise development process. First, we engaged national partners (NCPTSD, PCMHI) in creating an initial support tool content list. Second, a panel of 3 psychiatrists, one of whom co-chaired the VA/DoD PTSD CPG committee, refined and expanded the content domains. Third, using cognitive interviews, preliminary content domains and proposed presentation formats were reviewed with 6 primary care providers. Finally, feedback from stakeholder clinicians at study sites resulted in further refinement.

Results:
Using input from policy makers, content experts, end-users and other stakeholders, we created a provider support tool for point-of-care use in CPRS. Translating PTSD CPGs into provider support tools requires development of clear and concise practice points. Because psychiatrists vary in their practice styles and primary care providers differ in their comfort and familiarity with mental health treatment, flexibility had to be incorporated.

Implications:
Development of provider support tools to implement CPGs require both "fine-tuning" guideline recommendations and simultaneously providing a sufficient breadth of information to allow for flexible application.

Impacts:
The CPRS PTSD provider support tool will help primary care providers provide pharmacotherapy for their patients with PTSD and will facilitate communication with consulting psychiatrists.