November 2017

In this Issue: Improving Care of Mental Health Conditions
» Table of Contents

Primary Care-Based PTSD Intervention

Feature Article

Veterans with PTSD are offered referrals to specialty mental healthcare where evidence-based psychotherapies are available. Unfortunately, many patients refuse such referrals or, if accepted, infrequently attend enough sessions to receive adequate treatment. Consequently, a significant gap exists between the need for and engagement in effective PTSD treatment for Veterans seen exclusively in VA primary care. Innovative technology could help address this need by increasing access to and quality of PTSD treatment. VA's National Center for PTSD has developed PTSD Coach – an evidence-informed self-management mobile app that offers PTSD psycho-education, symptom monitoring, coping skills, and links to social support and professional resources. Study investigators have developed a treatment package that combines mobile technology with clinician support (CS). Pilot data indicate participation in CS PTSD Coach leads to clinically significant reductions in PTSD symptoms and increased engagement in specialty mental healthcare.

This ongoing randomized controlled trial (2016-2020) focuses on Clinician-Supported PTSD Coach in VA primary care with Veterans who have clinically significant PTSD symptoms. Specific aims are to investigate:

• The impact of CS PTSD Coach on PTSD symptom severity,
• The impact of CS PTSD Coach on engagement in two sessions of specialty mental healthcare, and
• Patient and provider satisfaction.

Investigators also will explore potential mediators (i.e., objective app use, coping self-efficacy) and moderators (i.e., baseline PTSD symptom severity, comorbid psychiatric symptoms) of outcomes. In addition, they will identify trajectories of PTSD symptom change over the four month follow-up period to determine whether engagement in specialty mental health treatment and continued app use interact with symptom change.

Impact: Bringing CS PTSD Coach into primary care could be an initial step in a stepped-care approach to provide patient-centered treatment that facilitates shared decision-making on treatment options, reduces PTSD symptoms, and prepares Veterans for more intensive treatments, if needed. If this treatment is found to be effective at reducing PTSD symptoms and increasing use of mental health care, it will provide a tremendous positive impact on Veterans with PTSD seen in VA primary care.

Principal Investigators:  Eric Kuhn, PhD, is part of HSR&D’s Center for Innovation to Implementation (Ci2i) in Palo Alto, CA, and Kyle Possemato, PhD is with the Center for Integrated Healthcare in Syracuse, NY.

Reverse order, so most current pub is first.

Publications:

Possemato K, Kuhn E, Johnson E, et al. Development and refinement of a clinician intervention to facilitate primary care patient use of the PTSD Coach app. Translational Behavioral Medicine. 2017;7:116-126.

Possemato K, Kuhn E, Johnson E, et al. Using PTSD Coach in primary care with and without clinician support: A pilot randomized controlled trial. General Hospital Psychiatry. 2016;38:94-98.

Primary Care-Based PTSD Intervention project abstract