Health Services Research & Development

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ESP Reports in Progress

ESP Reports  ESP Topic Nomination  ESP Reports in Progress

The following reports are under development at one of the four ESP sites. If you would like to provide comments about the topic under development, serve as a peer reviewer for the draft report, or know the timeline for completion, please contact the ESP Coordinating Center.

To review the most up-to-date protocols, please visit the PROSPERO website. Protocol registration numbers for an individual project can be found along with the brief abstract for the project, below.



Relationship of TBI to PTSD, Depression, Substance Abuse, Anxiety, and Suicidal Ideation: A Systematic Review

PROSPERO registration number: CRD42018083990

Background/Objectives of Review

This report will be used by the Veterans Health Administration TBI Advisory Committee to inform clinical practice guideline development. The report will also be used to inform Office of Research and Development future research priorities.

Key Questions

KQ1a: Is the prevalence of mental health conditions (post-traumatic stress disorder [PTSD], depression, substance abuse, suicidal ideation, and general anxiety disorders) differ in service members and Veterans with and without combat-deployed mild TBI?

KQ1b: How do severity and symptom persistence of mental health conditions (PTSD, depression, substance abuse, suicidal ideation, and general anxiety disorders) different in service members and Veterans with and without combat-deployed mild traumatic brain injury (TBI) (one or more)?

KQ2: What are the effectiveness and comparative effectiveness and harms of established pharmacological or nonpharmacological interventions for treatment of PTSD, depression, substance abuse, suicidal ideation, and general anxiety disorders in service members and Veterans with history of combat-deployed mild TBI-related symptoms?

PICOTS

Population(s): Service members and Veterans with one or more combat-deployed mild TBI(s).

Interventions: Combat-deployed mild TBI(s) (KQ 1-2); pharmacological interventions for the management of mental health conditions (KQ 2); nonpharmacological interventions for the management of mental health conditions (KQ 2).

Comparator: Veterans and service members without combat-deployed mild TBI(s) (KQ 1); placebo or alternative pharmacological or nonpharmacological intervention including wait-list controls (KQ 2).

Outcome(s): Prevalence, severity, and symptom persistence of PTSD, depression, substance abuse, suicidal ideation, or general anxiety disorder (short term ≤ 1 year, long term > 1 year) in service members and Veterans with and without combat-deployed mild TBI(s); effectiveness of interventions (ie, changes in symptoms, function, and quality of life measures and harms) for the treatment of mental health conditions of interest in service members and Veterans with and without combat-deployed mild TBI(s).

General Search Strategy

MEDLINE search using the search strategy below. We will also search PsycINFO, the PILOTS database, publications from VA HSR&D, and research for the Defence and Veterans Brain Injury Center.

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Pharmacotherapy for Stimulant Use Disorders: A Systematic Review

PROSPERO registration number: CRD42018085667

Background/Objectives of Review

The review will be used by the Office of Mental Health Services to inform national VHA policy on VA substance use disorder (SUD) treatment. CESATE will also disseminate the findings to the field to help ensure medication-assisted SUD treatments available to Veterans include the latest evidence on effectiveness and harms. This review also has the potential to inform future SUD research priorities by identifying gaps in the literature.

Key Questions

KQ1: What are the benefits and harms of pharmacotherapy for cocaine use disorder (alone, or as an adjunct or follow-up to psychosocial treatment)?

KQ2: Are there known subpopulations for which different forms of pharmacotherapy is most/least effective for cocaine use disorder?

KQ3: What are the benefits and harms of pharmacotherapy for amphetamine/methamphetamine use disorder (alone, or as an adjunct or follow-up to psychosocial treatment)?

KQ4:  Are there known subpopulations for which different forms of pharmacotherapy is most/least effective for amphetamine/methamphetamine use disorder?

PICOTS

Population(s): Included: Non-pregnant adults with cocaine or amphetamine/methamphetamine use disorder.

Excluded: subjects with psychotic spectrum disorder, bipolar disorder.

Interventions: Included: Pharmacotherapies identified as a potential treatment for cocaine or amphetamine/methamphetamine use disorder (common adjuncts may be med management; interpersonal therapy; contingency management (or motivational incentives); CBT (including matrix therapy, relapse prevention)

Excluded:  treatment for temporary psychosis associated with stimulant overdose.

Comparator: Usual care, placebo, or other interventions (control groups should receive the same adjunctive treatments)

Outcome(s): Intermediate/Behavioral outcomes: Abstinence (UTS only; self-report only in addition to UTS); Also of interest when available: Longest Duration of Abstinence (LDA), and whether patients reach at least Three Consecutive Weeks (21 or more days) of abstinence. Reduction of cocaine use (eg, last 30 days, last 3 months, ASI included number of days of use, quantitative urine levels). Retention in treatment.

Health and other outcomes: Morbidity/mortality; Quality of Life; Legal/employment outcomes

Harms: Withdrawal due to AE, and severe AE (as reported in the trials)

General Search Strategy

Search strategies will be developed in consultation with a research librarian, and will be peer reviewed by a second research librarian using the instrument for Peer Review of Search Strategies (PRESS). We plan to conduct a primary review of the literature by systematically searching, reviewing, and analyzing the scientific evidence as it pertains to the research questions. To identify relevant articles, we will begin by searching Ovid MEDLINE, OvidPsycINFO, and Ovid EBM Reviews Cochrane Database of Systematic Reviews (CDSR, DARE, HTA, Cochrane CENTRAL, etc). We will search all available years of publication from database inception (1946 for Ovid MEDLINE) through November 2017. We will review the bibliographies of relevant articles and contact experts to identify additional studies. To identify in-progress or unpublished studies, we will search ClinicalTrials.gov, OpenTrials, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).

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Best Emergency Department Practices for Older Adults

PROSPERO registration number: CRD42018087660

Key Questions

How effective are Emergency Department health system interventions in improving clinical, patient experience, and utilization outcomes in older adults (age ≥ 65)?

Health system interventions may include one or more of the following strategies:

  • Transitional care/discharge planning
  • Comprehensive geriatric assessment with linkage to services or changes to the care plan based on this assessment
  • Case management
  • Medication safety programs/polypharmacy
  • Geriatric emergency departments designed to conform to the 2014 ACEP guidelines.

PICOTS

Population(s): Adults age 65 and older who present to an emergency department for acute/urgent/emergency care or are identified from ED logs to target for a follow-up intervention that occurs outside the ED.

Interventions: Transitional care/discharge planning; Comprehensive geriatric assessment with linkage to services or changes to the care plan based on this assessment; Case management; Medication safety programs/polypharmacy; Geriatric emergency departments designed to conform to the 2014 ACEP guidelines.

Comparator: Usual emergency department care or enhanced usual emergency department care.

Outcome(s): Clinical outcomes (functional status, quality of life, mortality); Patient satisfaction/experience; Care utilization (ED readmission up to 90 days following index visit, hospitalization following ED discharge); We will track whether studies report costs, but because the data are likely skewed and/or infrequently reported, and thus may not be relevant to VA, we will not synthesize cost data.

General Search Strategy

We will conduct a primary search of MEDLINE® (via PubMed®), Embase, and CINAHL. We anticipate using a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian. Because we identified recent high-quality systematic reviews and an evidence map on relevant topics, our search will be designed to start 6 months prior to the search strategy from these reviews. In addition, we will search the gray literature via ClinicalTrials.gov and SCOPUS.

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