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IAC 09-040 – HSR&D Study

IAC 09-040
Prolonged Exposure (PE) for PTSD: Telemedicine vs. In Person
Ron E. Acierno PhD MS BA
Ralph H. Johnson VA Medical Center, Charleston, SC
Charleston, SC
Funding Period: July 2010 - June 2015

Approximately 15 to 17% of current Iraq war veterans meet full diagnostic criteria for MH problems such as post-traumatic stress disorder (PTSD) (Hoge et al., 2004). Prolonged Exposure (PE) is an empirically supported treatment for PTSD (Foa 1997; Schnurr et al., 2007), and has been adopted by the VAMC as one of the treatments of choice for the disorder, as evident by the VAMC-sponsored national training of clinicians to use PE. It is therefore important to employ treatment delivery methods that maximize the likelihood that all veterans in need, including veterans residing in rural settings, and veterans who avoid VAMC settings due to the stigma of receiving mental health treatment, will receive interventions such as PE. The May, 2005 Committee on Veterans Affairs, Subcommittee on Health has identified Telemedicine as a VA priority area to address this need. The present study was conducted to determine whether PE delivered via Telemedicine is as effective as PE delivered In Person. Home-based Telemedicine has been chosen for its ability to overcome what appear to be two major barriers to mental health care (Frueh et al., 2000): the difficulty that rural-residing veterans face in reaching VAMC facilities, and the stigma veterans perceive related to receiving mental health treatment. Indeed, if effective, PE delivered via telemedicine may address the problem inherent in the finding that 42% of those screening positive for PTSD indicate that they are interested in receiving help, but only 25% actually receive services (Hoge, et al., 2006).

Although effective treatments for PTSD exist and have been adopted by the VAMC, barriers to care of a social (e.g., stigma) and geographic (e.g., rural) nature prevent many veterans in need from receiving care. Telemedicine might address this need. The major objective of this study was to determine if PE delivered via Telemedicine is as effective as In Person PE.

We used a randomized between groups repeated measures (baseline, post-treatment, 3 & 6-month followups) design with 153 Veterans diagnosed with PTSD to assess the relative effectiveness of PE delivered via Home BasedTelemedicine vs. In Person formats. We hypothesize that no differences (i.e., non-inferiority) between the two formats will be evident in terms treatment gains, patient satisfaction, treatment attrition, patient satisfaction and direct healthcare costs.

-Data were available from 154 Veterans
-96.1% were male, average age 42 years, 55% were married, 36% were Black, 41% had at least 50% service connection. There were no differences on any of these variables across conditions.
-Average # of sessions completed (about 8 of 12) was not significantly different for in person ( N = 77) vs. telemedicine (N = 76) delivered PE (F(1,131) = 3.6, p = .06).
-Both groups demonstrated significant pre-post reductions on PTSD scores from a mean PCL of 59 at Baseline to 43 at post, to 47 at 9 months (F(3,453) = 112.1, p<.001). There were no significant differences between groups on the PCL at any time point.
-Both groups demonstrated significant pre-post reductions on Depression scores from a mean BDI of 29 at Baseline to 20 at post, to 20 at 9 months (F(3,453) = 57.1, p<.001)
-There were no significant differences between groups on PTSD Scores at any time point
-There were no significant differences between groups on Depression Scores at any time point)

This study indicates that PE delivered via home-based Telemedicine equipment is no less effective than traditional In Person delivery of PE for post-traumatic stress disorder. As such, this study opens the path to justify delivery of mental health PTSD care directly into Veterans' homes, without the need for long commutes, experienced stigma, high travel cost, or significantly missed work. In fact, this study indicates that they can receive best practices, gold standard evidence based treatments for PTSD in the form of Prolonged Exposure safely, effectively, and at greatly reduced effort, and that this treatment can be delivered to rural areas, underserved areas, and to those with PTSD who may specifically avoid traditional VA mental health care settings (eg, MST victims).

External Links for this Project

NIH Reporter

Grant Number: I01HX000152-01A1

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None at this time.

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Prevention, Treatment - Efficacy/Effectiveness Clinical Trial, Treatment - Observational
Keywords: Comparative Effectiveness, Psychiatric health care delivery, PTSD
MeSH Terms: none

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