RESPECT-PTSD: Re-Engineering Systems for the Primary Care Treatment of PTSD, A Randomized Controlled Trial

Schnurr, Paula P.; Friedman, Matthew J.; Oxman, Thomas E.; Dietrich, Allen J.; Smith, Mark W.; Shiner, Brian; Forshay, Elizabeth; Gui, Jiang; Thurston, Veronica

doi:10.1007/s11606-012-2166-6

Cited by 68 publications

(63 citation statements)

References 45 publications

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“…Of veterans with a new treatment episode for PTSD, 39 percent received some counseling during the six months after diagnosis in -2005(Spoont et al, 2010. Of veterans with a new treatment episode for PTSD, 53.5-55.2 percent received some psychotherapy in the six months after diagnosis in (Schnurr et al, 2013. Of veterans newly diagnosed as having PTSD, 45 percent received PTSD-related psychotherapy in a 12-month period in (Shin et al, 2014.…”

Section: Comparative Results From Other Sourcesmentioning

confidence: 99%

“…Of veterans with a new treatment episode for PTSD, 6.1-8.3 percent received nine or more psychotherapy visits in the 15 weeks after diagnosis in 2008-2010 (Schnurr et al, 2013). Of veterans newly diagnosed as having PTSD, 8 percent received eight or more PTSD-related psychotherapy visits in the first 14 weeks after diagnosis in (Shin et al, 2014.…”

Section: Comparative Results From Other Sourcesmentioning

confidence: 99%

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Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

Hepner¹,

Sloss²,

Roth³

et al. 2016

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. For more information on this publication, visit www.rand.org/t/RR978 Support RANDPublished by the RAND Corporation, Santa Monica, Calif. © Copyright 2016 RAND CorporationR® is a registered trademark. Cover: U.S. Air Force photo by Senior Airman Tabatha Zarrella iii PrefaceThe U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Given the rates of posttraumatic stress disorder (PTSD) and depression among U.S. service members, attention has been directed to ensuring the quality and availability of programs and services targeting these and other psychological health (PH) conditions. Understanding the current quality of care for PTSD and depression is an important step toward future efforts to improve care across the MHS.To help determine whether the service members with PTSD and/or depression are receiving evidence-based care and whether there are disparities in care quality by branch of service, geographic region, and service member characteristics (e.g., gender, age, pay grade, race/ethnicity, deployment history), DoD's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to conduct a review of the administrative data and medical records of service members diagnosed with PTSD and/or depression and to recommend areas on which the MHS could focus its efforts to continuously improve the quality of care provided to all service members.This report should be of interest to MHS personnel who provide care for service members with PTSD and/or depression. It should also be useful to those responsible for monitoring the quality of that care and developing evidence-based quality measures to improve care for service members and individuals with PTSD or depression in other health systems.This research was sponsored by DCoE and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of ...

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Section: Comparative Results From Other Sourcesmentioning

confidence: 99%

Section: Comparative Results From Other Sourcesmentioning

confidence: 99%

Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

Hepner¹,

Sloss²,

Roth³

et al. 2016

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“…However, the rate of nonadherence was relatively high among patients in the PCM intervention; only 73 % of the PCM patients completed the initial face-to-face visit with the CM and PCC. By comparison, in RESPECT-PTSD, 26 89 % of the veteran participants referred to the program established contact. 3 The treatment arm in the CALM study had an adherence rate of 96 %.…”

Section: Discussionmentioning

confidence: 96%

“…25 The Re-Engineering Systems for the Primary Care of PTSD (RESPECT-PTSD) trial for veterans with PTSD did not find an intervention effect for symptoms or functioning. 26 A third trial of telemedicinebased collaborative care for PTSD was effective for engaging veterans in psychotherapy and reducing symptoms, but only for those receiving cognitive-behavioral therapy. 27 These mixed findings call for more research to test collaborative care for PTSD.…”

Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

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BACKGROUND:The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement. CONCLUSIONS:A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.

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“…2 In two primary care trials involving Veterans, one showed a minimal effect on PTSD severity, 3 whereas the second showed a modest effect size of 0.31 to 0.45. 4 However, the first trial 3 was conducted in VA Medical Centers where patients had ready access to mental health, resulting in an average of 4.2 psychotherapy visits in both collaborative care and usual care groups.…”

mentioning

confidence: 99%

Capsule Commentary on Meredith et al., Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: A Randomized Controlled Trial

Kroenke

2016

J GEN INTERN MED

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T he randomized clinical trial by Meredith et al. showed that collaborative care and minimally enhanced usual care were equally effective for post-traumatic stress disorder (PTSD). 1 The improvement rates in both groups were remarkably high, with effect sizes for PTSD severity reduction exceeding 1.5 SD and nearly 60 % of participants no longer meeting diagnostic criteria for PTSD at 1 year. Reasons for a negative trial might include enrollment of patients with less severe PTSD and a more favorable natural history, a stronger than expected effect of training in the enhanced usual care group, or a weaker than expected collaborative care intervention.The CALM trial for anxiety disorders in 1004 primary care patients showed a moderate but nonsignificant effect size of 0.48 for PTSD; however, only 6 % of participants had a principal diagnosis of PTSD. 2 In two primary care trials involving Veterans, one showed a minimal effect on PTSD severity, 3 whereas the second showed a modest effect size of 0.31 to 0.45. 4 However, the first trial 3 was conducted in VA Medical Centers where patients had ready access to mental health, resulting in an average of 4.2 psychotherapy visits in both collaborative care and usual care groups. In contrast, the second trial 4 enrolled from community-based clinics often located in rural areas, leading to far more psychotherapy sessions in the telecare group compared to usual care group (4.2 vs. 0.8). Notably, both this latter trial and the CALM trial assured more uniform delivery of evidence-based psychotherapy than either of the two negative trials.In contrast to this small number of collaborative care trials with mixed results for PTSD, there have been more than 70 trials establishing the benefits of collaborative care for depression. 5 Whereas medications and psychotherapy are equally effective for depression, psychotherapy may be especially important for optimal outcomes in PTSD. It is also possible that the type of trauma (e.g., combat, interpersonal violence or abuse, accidents or natural disasters) and severity of symptoms may lead to differential treatment responses. The movement towards integrating medical and behavioral health services may be most critical for disorders where pharmacotherapy alone is insufficient.

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RESPECT-PTSD: Re-Engineering Systems for the Primary Care Treatment of PTSD, A Randomized Controlled Trial

Cited by 68 publications

References 45 publications

Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Capsule Commentary on Meredith et al., Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: A Randomized Controlled Trial

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