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:

* Currently being seen at one of the clinics participating in this study
* Diagnosis of or treated for a mood disorder (bipolar disorder or depression)
* Ability to speak and read English and provide informed consent

Exclusion Criteria:

* No active substance intoxication
* No acute medical illness or dementia
B: Inclusion Criteria:

* Patients must be:

  1. at least 18 years old,
  2. have Type II Diabetes, and
  3. receive care in a participating practice.
* For a practice to be eligible, they must be;

  1. a Federally Qualified Health Center,
  2. a private primary care practice, or
  3. Community Mental Health Center with primary care,
  4. They need to have

     1. a current panel of at least 150 adult patients with Type 2 Diabetes, and
     2. access to health educators, Behavioral Health Professionals, and diabetes peer mentors.

Exclusion Criteria:

* Are currently pregnant or plan to become pregnant in the next six months,
* Have limited cognitive ability due to dementia or a developmental disorder,
* Less than one year of life expectancy, or
* Plan to leave the area in the next year.
C: 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
D: Inclusion Criteria:

* Diagnosis of serious mental illness (schizophrenia, bipolar disorder, other psychosis, major depressive disorder, or other recurrent depression or affective disorder)
* Have at least one of the following risk factors for CVD (cardiovascular disease):

  * Body mass index (BMI) \>28 or waist circumference of \>35 (women) or \>40 (men) inches OR
  * Self-reported diagnosis of hypertension ("high blood pressure"), dyslipidemia ("high cholesterol") or diabetes or high blood sugar OR
  * Documentation in the medical record of a diagnosis of or treatment for hypertension (defined as documented diagnosis or blood pressure of \>140/90 on 2 occasions or prescription for an antihypertensive medication), dyslipidemia (documented diagnosis or LDL\>160 or prescription for a lipid-lowering medication) or diabetes mellitus (documented diagnosis or HbA1C \>7% or current prescription for oral hypoglycemic therapy)

Exclusion Criteria:

* Have unresolved substance intoxication or withdrawal, such as appearing to be intoxicated (e.g., incoherent, slurred speech), or experiencing withdrawal symptoms from substance abuse at the time of enrollment.
* Are unwilling or unable to provide informed consent or comply with study requirements at the time of enrollment (e.g., unable to complete forms or attend sessions due to substantial functional limitations).
* Active suicidal ideation at time of enrollment (focused interventions are more appropriate for this group)

Answer: C