Telephone-based Care for OEF/OIF Veterans With PTSD
Condition: Post-Traumatic Stress Disorder
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Objective: OEF/OIF (Operation Enduring Freedom and Operation Iraqi Freedom) veterans are
      presenting with high rates of PTSD. Translating Initiatives for Depression into Effective
      Solutions (TIDES) is a model of phone-based care being implemented nationally as a model to
      address those patients suffering from depression, PTSD, or alcohol use disorders. However,
      evidence-based treatments do not yet exist for phone-based management of OEF/OIF veterans who
      suffer from PTSD.

      Research Plan:

      This is an open trial to assess feasibility of augmenting standard treatment of PTSD with
      TIDES based telephone-based nurse care management.
    

Detailed description: 
      Background:

      Veterans from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) present with
      high rates of post-traumatic stress disorder (PTSD) and depressive disorders, but may
      experience barriers to specialty mental health (MH) care. Recent research suggests the
      majority of OEF/OIF veterans referred to MH for PTSD or depression fail to attend the
      recommended number of appointments within the first year. The TIDES (Translating Initiatives
      for Depression into Effective Solutions) model of collaborative care management for
      depression is an evidence-based option for VA primary care settings. However, patients in
      TIDES care management often have co-morbid PTSD, and the current model does not include
      PTSD-specific tools.

      Objectives:

      The primary objectives of the project were to assess feasibility and acceptability of (1)
      adapting TIDES tools and protocols to include PTSD and depression in the management of
      OEF/OIF patients, and (2) implementing the adapted model to augment treatment as usual in the
      VA Seattle-Puget Sound Deployment Health Clinic (DHC).

      Methods:

      We conducted a pilot implementation of the TIDES/PTSD model in a single site that provides
      integrated care specifically for OEF/OIF veterans. TIDES CPRS (Computerized Patient Record
      System) templates were adapted to include assessment and monitoring for PTSD. Phone-based
      care management protocols were expanded to include PTSD in three clinical domains: (1)
      medication management, (2) psychosocial support, and (3) patient self-management support,
      including the optional workbook "Strategies for Managing Stress After the War: Veterans
      Workbook." The templates were written in VA Class 1 Software, and clinical data were coded as
      Health Factors, allowing for automatic collection into the VISN 20 Data Warehouse. TIDES Care
      Managers were trained to use these templates, protocols, and workbook. Clinical staff
      received an orientation to the model of care. We enrolled 20 patients, newly initiating care
      at the DHC, who had a clinical diagnosis of PTSD and score of 50 or greater on the PTSD Check
      List-Military version (PCL-M). Co-morbid depression, if present, was defined by clinical
      diagnosis and a score of 10 or greater on the nine-item Patient Health Questionnaire (PHQ-9).
      Patients were followed by a Care Manager for up to six months. Formative evaluation included
      utilization data, clinical data, and qualitative data from semi-structured interviews of
      clinical staff and patients on their experiences with the model.

      Status:

      Final report.
    

Intervention name(s): Phone-based outreach
Intervention type(s): Other
Intervention description(s): Nurse care managers will use a phone call outreach intervention with structured templated notes to help deliver evidence-based care for PTSD
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: telephone-based intervention for PTSD