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2019 HSR&D/QUERI National Conference Abstract

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1072 — Lessons Learned from a Formative Evaluation of an Implementation Intervention to Improve Rural PTSD Care

Lead/Presenter: Nancy Bernardy,  Office of Rural Health and NCPTSD
All Authors: Bernardy NC (National Center for PTSD, Giesel School of Medicine), Montano, M. (National Center for PTSD, White River Junction VA Medical Center), Cuccurullo, L. (National Center for PTSD, White River Jct., VT) Lee, P. (VA Office of Rural Health, White River Jct., VT) Lee, R. (VA Office of Rural Health, White River Jct., VT) Breen, K. (National Center for PTSD, White River Jct., VT)

Objectives:
We used external facilitation and academic detailing to disseminate and improve access to evidence-based psychotherapies and pharmacotherapies for PTSD in rural VA clinics in New England. The Promoting Action on Research Implementation in Health Services informed our implementation and evaluation work and this study describes preliminary results.

Methods:
Formative data included local needs assessment surveys and face-to-face site visit outreach with 164 staff and process data on barriers and facilitators to delivery of PTSD Clinical Practice Guideline (CPG) recommended treatments. Evaluation data included clinician survey results, identification of barriers and facilitators, Veteran survey results, pharmacotherapy data, and post-intervention surveys with clinic staff. Interviews were analyzed using a card sorting approach.

Results:
Barriers identified across rural clinics included a lack of awareness of the PTSD CPG recommendations, low engagement in PTSD psychotherapies, and lack of availability of trained providers. Solutions developed in concert with providers included training clinicians in a briefer, recommended trauma-focused treatment, direct mailing outreach to Veterans of a brochure on the harms of benzodiazepines, links to a telehealth service hub, development of a community of practice lecture series and sharing of resources. Post-intervention prescribing data of the mailing outreach to Veterans showed improvement in benzodiazepine prescriptions, particularly in Veterans on higher doses. Veteran surveys noted an increased recognition of the harms of continued benzodiazepine use. Qualitative and quantitative results from the provider training indicated high satisfaction levels and use of the therapy in clinical practice.

Implications:
An improved plan for dissemination of the PTSD CPG is needed, particularly to Primary Care Providers who are often the first point of care for rural Veterans with PTSD. There is also a need for increased education about the benefits of evidence-based psychotherapy for PTSD at the provider, Veteran level, and with non-clinical staff.

Impacts:
The use of facilitation and academic detailing has the potential to aid quality improvement efforts at the team level to identify gaps and help rural clinics address barriers to quality PTSD care for their patients. Direct to consumer approaches may complement these interventions in a more direct method to improve care.