Prolonged Exposure (PE) for Post Traumatic Stress Disorder (PTSD): Telemedicine Versus In Person
Condition: PTSD
MeSH terms: Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The present proposal is to study whether Prolonged Exposure (PE) delivered via Telemedicine
      is as effective as PE delivered In Person for Operation Iraqi Freedom (OIF), Operation
      Enduring Freedom (OEF) Veterans and Veterans of all theatres, particularly Vietnam era with
      Post-Traumatic Stress Disorder (PTSD). ).
    

Detailed description: 
      Project Background/Rationale: 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 Department of Veterans Affairs (DOVA) as
      one of the treatments of choice for the disorder, as evident by the DOVA-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 DOVA 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 DOVA priority area to
      address this need. The present proposal is to study whether PE delivered via Telemedicine is
      as effective as PE delivered In Person. 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).

      Project Objectives: Although effective treatments for PTSD exist and have been adopted by the
      Veterans Affairs Medical Centers (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 is to determine if PE
      delivered via Telemedicine is as effective as In Person PE in terms of (1) clinical; (2)
      process; and (3) economic outcomes.

      Project Methods: The investigators propose to use a randomized between groups repeated
      measures (baseline, post-treatment, 3& 6-month followups) design with 226 OIF-OEF Veterans
      diagnosed with PTSD to assess the relative effectiveness, measured in terms of symptoms,
      patient satisfaction, and costs, of PE delivered via Telemedicine vs. In Person formats. The
      investigators 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 health care costs.

      Anticipated Impacts on Veterans Health care: This study will provide important information
      regarding whether PE delivered via home-based Telemedicine equipment is as effective as
      traditional In Person delivery of PE for post-traumatic stress disorder. If shown to be as
      effective as In Person treatment, a new, innovative, and cost effective intervention delivery
      system for PTSD will have initial empirical support.
    

Intervention name(s): Telemedicine; In Person
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Prolonged Exposure (PE) therapy provided at patients house via telemedicine; PE therapy delivered in person at the VAMC
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Anxiety Disorders: PTSD; Prolong Exposure (PE); Telemedicine; cost effectiveness; deployment related problems; mental health care delivery