Please select the eligibility criteria that correspond to the clinical trial below.
Title: Telemedicine Outreach for Post Traumatic Stress in CBOCs
Brief Summary: The purpose of this study is improved outcomes for veterans with Post Traumatic Stress Disorder (PTSD) treated in small VA Community Based Outpatient Clinics (CBOCs). Although psychotherapy and pharmacotherapy treatments for PTSD have been proven to be efficacious in controlled trials, geographic barriers often prevent veterans from accessing these evidence-based treatments. Telemedicine technologies will be used to overcome geographic barriers to care. Specifically, we will evaluate the Telemedicine Outreach for PTSD (TOP) intervention which is based on the principals of the Chronic Care Model and Disease Management, and builds on the evidence base of quality improvement for depression in primary care settings. The TOP intervention will employ an off-site PTSD care team (tele-psychiatrist, tele-psychologist, tele-pharmacist, and tele-nurse care manager) and will use telemedicine technologies (telephone, interactive video and electronically shared medical records) to treat CBOC patients with a newly emerging or chronic PTSD. We hypothesize that study participants randomized to the TOP intervention will receive higher quality of care and experience better outcomes compared to study participants randomized to treatment as usual.


Options:
A: Inclusion Criteria:

* diagnostic Criteria for PTSD (CAPS),
* veterans,
* treated in CBOC

Exclusion Criteria:

* schizophrenia,
* bipolar disorder,
* current substance dependence,
* current specialty PTSD treatment at VA Medical Center,
* no access to telephone,
* hearing or speech impediment,
* terminal illness,
* non-capacity to consent
B: Inclusion Criteria:

* Enrolled as a pt in the VA Healthcare System
* screens positive for major depression
* has a scheduled visit at a primary care site taking part in the study

Exclusion Criteria:

* severe alcohol abuse
* psychosis
* dementia
* acutely suicidal (at screening)
* lack of access to or ability to use a phone
C: Inclusion Criteria:

* Meets criteria for clinically significant depression based on a score of ≥ 2 for one of the two cardinal depression symptoms (depressed mood or loss of interest) and a Patient Health Questionnaire-9 total score of ≥ 10
* Patient with heart disease
* Has attended Los Angeles County Department of Health Services Comprehensive Health Clinics or the Cardiology Clinic at Los Angeles County+University of Southern California Medical Center

Exclusion Criteria:

* Current suicidal ideation
* Score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT)
* Recent use of lithium or antipsychotic medication
D: Inclusion Criteria:

* MINI diagnosed Anxiety Disorder (PTSD, GAD, SAD, PD)
* Speak English or Spanish (English only at UAMS site)

Exclusion Criteria:

* Diagnosis of Bipolar 1
* Drug and alcohol dependence; or abuse of any substance other than marijuana and alcohol
* Acute suicidality or homicidality

Eligible subjects must be current patients at one of the participating primary care clinics which include:

University of Washington:

* Harborview's Adult Medicine Clinic
* Harborview's Family Medicine Clinic
* UWMC's General Internal Medicine Clinic at Roosevelt Clinic
* PSNHC's 45th Street Clinic
* Country Doctor Community Clinic
* Carolyn Downs Family Medical Center

UCLA:

* Desert Medical Group, Palm Springs CA
* High Desert Medical Group, Lancaster, CA

UCSD:

* Kaiser Permanente, Bonita Medical Offices
* Kaiser Permanente, Otay Mesa Outpatient Medical Center
* UCSD Medical Center, Scripps Ranch Medical Office
* UCSD Medical Center, Fourth and Lewis Medical Office
* UCSD Medical Center, Perlman Ambulatory Care Center
* Sharp Rees-Stealy Medical Group, El Cajon
* Sharp Rees-Stealy Medical Group, Mira Mesa

UAMS:

* UAMS UPMG
* Little Rock Diagnostic Clinic
* St. Vincent's Family Clinic South

Answer: A