Randomized controlled equivalence trial comparing videoconference and in person delivery of cognitive processing therapy for PTSD

Abstract

This study highlighted research and clinical challenges in providing services to the newest veteran generation in general as well as unique challenges with VTC. One complicating factor to the statistical power of this study was a treatment dropout rate twice the original estimate. Factors that could have influenced this high dropout rate are explored.

“Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?”: Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals

“…Studies that have compared telemedicine with face-to-face delivery of PTSD treatment in veteran samples have consistently found that telemedicine and as face-to-face care are equally effective (Acierno et al, in press; Egede et al, 2015; Maieritsch et al, 2015; Morland et al, 2015; Yuen et al, 2015). Previous studies have compared telemedicine to in-person modalities for the treatment of PTSD using cognitive processing therapy with Iraq/Afghanistan veterans (Maieritsch et al, 2015), cognitive processing therapy with female veterans (Morland et al, 2015), and PE among veterans in RCTs (Yuen et al, 2015) and in effectiveness settings (Gross et al, 2011; Tuerk et al, 2010).…”

“…Previous studies have compared telemedicine to in-person modalities for the treatment of PTSD using cognitive processing therapy with Iraq/Afghanistan veterans (Maieritsch et al, 2015), cognitive processing therapy with female veterans (Morland et al, 2015), and PE among veterans in RCTs (Yuen et al, 2015) and in effectiveness settings (Gross et al, 2011; Tuerk et al, 2010). Further, in relation to attrition, a recent systematic review indicated that drop-out rates did not differ between those who were treated via telemedicine and those treated in-person across samples of veterans who served in Iraq and Afghanistan (Goetter et al, 2015).…”

“…PTSD treatment via standard telemedicine (i.e., central hub clinic to distal satellite clinic) and HBT have thus far been found to be non-inferior to the same treatment delivered in-person (Acierno et al, in press; Egede et al, 2015; Maieritsch, et al, 2015; Morland, et al, 2015); and to yield comparable dropout rates for veterans (Hernandez-Tejada, Zoller, Ruggiero, Kazley, & Acierno, 2014). HBT is thus a promising mode of PTSD service delivery to female veterans with MST that allows for enhanced treatment access.…”

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…Limited education, clinical exposure, and hands-on learning in telepsychiatry are significant barriers to expanding use. 8,11,20,27,28,31,35,38,40,47,59,89,104,105,[107][108][109][110] Telepsychiatry education in medical school and residency is minimal, 8,47,110 with only 21 of 183 US residency training programs offering any training or experience in telepsychiatry. 12 The burden largely falls on individual psychiatrists to seek out the knowledge and experience required to become competent in telepsychiatry.…”

“…31,54,131 Clinical office space is often a barrier. 107,108 For basic setup, one needs an appropriate room (well lit; with the ability of the camera to pan, tilt/zoom, and see all who are present; toys that are not noisy for children; well-placed microphones; rooms large enough for several people, but not too large that younger kids will wander; a dark background; diffuse lighting to reduce glare; and heavy chairs to reduce movement on screen). 16,51,77 In some care models, it may also be necessary to employ staff to physically be present to aid in support activities such as physical examination and vital signs, maintaining medical records, obtaining consent, registering and scheduling patients, fielding calls from families, solving technical and equipment problems, intervening in case of emergency or crisis, coordinating care with local clinicians and services, and coordinating laboratory results and prescriptions.…”