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2015 HSR&D/QUERI National Conference Abstract

3052 — An Educational and Training Program Designed to Improve Treatment of PTSD in Rural Veterans

Bernardy NC, National Center for PTSD, White River Jct, VT; Dutton TM, National Center for PTSD, White River Jct, VT; Sherrieb K, National Center for PTSD, White River Jct, VT; Jenkyn AJ, National Center for PTSD, White River Jct, VT;

Objectives: To provide preliminary data to inform a program across rural community based outpatient clinics (CBOCs) in Vermont on variation in prescribing patterns for providers and increase the use of effective pharmacotherapies and psychotherapies using an Academic Detailing model.

Methods: This VHA Rural Health Education and Training Program utilizes a mental health clinical pharmacist to promote the use of effective PTSD treatment practices and to decrease inappropriate medication use. The pharmacist offers outreach visits in person and via telehealth that provide customized education related to prescribing practices, barrier-resolution strategies and case consultation with clinicians. The project required the development of a prescription database that captures individual clinician caseloads of patients with a diagnosis of PTSD, comorbidities, and all prescribed psychotropic medications.

Results: Across our main facility and the 6 rural CBOCS, 3,156 Veterans treated for a mental health concern have a PTSD diagnosis (34.2%). The percent of patients with a PTSD diagnosis across sites is consistent with little variation. There is tremendous variation, however, in resources. Some CBOCs have a full-time psychotherapist trained in PTSD evidence-based treatments, others have full-time psychiatric support and some locations only have these services available from the main facility via telehealth. A review of psychotropic medications reveals variation among CBOCs in the use of prazosin, an alpha-1 adrenergic antagonist effective in treating trauma-related nightmares in patients with PTSD (6% - 20%) and highlights a specific need for education and training.

Conclusions: Findings using our developed dashboard allow us to customize education and training efforts for unique needs at the rural clinics. These interventions by the clinical pharmacist then facilitate a conversation about safer, more effective treatment options on a case-by-case basis. Our model for this program promotes safer medication choices and awareness of psychotherapy options for Veterans with PTSD by working individually with clinicians.

Use of our academic detailing model promotes safer medication choices for rural Veterans with PTSD by working individually with clinicians and supporting shared-decision-making treatment options between Veterans and clinicians.