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2015 HSR&D/QUERI National Conference Abstract

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3155 — Telephone Care Management in Outpatient PTSD Treatment

Azevedo KJ, National Center for PTSD, VA Palo Alto Health Care System; Tiet QQ, National Center for PTSD, VA Palo Alto Health Care System; Harris AS, Center for Health Care Evaluation, VA Palo Alto Health Care System; Greene C, VA Palo Alto Health Care System; Wood AE, VA Puget Sound Health Care System; Calhoun PS, Durham VA Medical Center; Bowe TR, VA Palo Alto Health Care System; Greenbaum MA, VA Palo Alto Health Care System; Schnurr PP, National Center for PTSD, Executive Division; Rosen CS, National Center for PTSD, VA Palo Alto Health Care System

Objectives:
Collaborative care can improve management of psychiatric problems in primary care, but it has not been applied to PTSD treatment in outpatient settings. This multi-site, randomized controlled trial tested whether adding telephone monitoring and support to usual PTSD outpatient care improved patients' treatment adherence and outcomes.

Methods:
355 veterans entering PTSD outpatient treatment at three VA facilities were randomized to treatment as usual (TAU, n = 165) or TAU augmented with telephone care management (TCM, n = 190). Patients in the TCM arm received up to 6 biweekly telephone calls during the first 3 months of treatment. Veterans' PTSD symptoms, depression, substance use, violence, and quality of life were assessed using validated self-report measures at intake, 4 months (67% response rate), and 12 months post-intake (60% response rate). Treatment utilization and medication refills were determined from VA administrative data. Treatment attendance in both arms was compared using negative binomial regression analyses. Clinical outcomes in both conditions were compared using multi-level modeling with multiple imputation of missing data.

Results:
97% of veterans in the TCM arm were reached by telephone and 77% completed 5 or more out of 6 planned calls. Veterans randomized to TCM completed more mental health visits (5.9 +/- 5.9) in the three-month intervention period than did those randomized to TAU (4.3 +/- 6.0; binomial beta = .369. p < .002). Treatment attendance in the subsequent 9 months and refills of SSRI/SNRIs and Prazosin did not differ by condition. Course of PTSD symptoms, depression, alcohol problems, violence and QOL did not differ by condition at both 4- and 12-month post-intake. Of note, only 33 (9.1%) study participants were scheduled to receive evidence-based psychotherapy for PTSD.

Implications:
Telephone care management improved initial treatment attendance but did not enhance veterans' clinical outcomes. Care management can have stronger effects on outcomes when veterans are offered access to evidence-based PTSD treatment (Fortney, Pyne, Kimbrell et al., 2015).

Impacts:
Telephone care management is a component of the Behavioral Health Interdisciplinary Program Model which improves mental health treatment attendance, and is likely to improve outcomes for treatments that are known to be effective.