Veterans Telemedicine Outreach for PTSD Services
Condition: PTSD
MeSH terms: Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Post-Traumatic Stress Disorder (PTSD) is considered a major public health problem in the U.S.
      due to its high prevalence and high rates of disability associated with the disorder. For
      thousands of veterans, PTSD is a chronic disorder, resulting directly from military service
      that causes substantial psychological suffering and social disability. Barriers to PTSD care
      include poor access, mistrust, and lack of benefit from traditional treatments. This project
      addresses two very important and timely questions. First, can telemedicine be used as a tool
      to extend effective, specialized mental health services such as, cognitive processing therapy
      (CPT), to veterans with poor access to care? Second, does therapy delivered by telemedicine
      effect the quality of care in terms of clinical outcomes (PTSD severity, Quality of Life),
      and the quality of patient-therapist interaction (patient satisfaction & communication)? By
      answering these questions, this study will provide valuable knowledge for VA researchers,
      clinicians, and policy makers. The study findings will have direct implications related to
      making specific recommendations regarding telemedicine utilization to deliver specialized
      mental health services for veterans suffering from PTSD.
    

Detailed description: 
      Anticipated Impact on Veterans' Healthcare: This project addresses two very important and
      timely questions related to the VHA's mission to provide state of the art care to OEF and OIF
      veterans. First, can telemedicine be used as a tool to extend effective, specialized mental
      health services such as, cognitive processing therapy (CPT), to veterans with poor access to
      care? Second, does therapy delivered by telemedicine effect the quality of care in terms of
      clinical outcomes (PTSD severity, Quality of Life), and the quality of patient-therapist
      interaction (patient satisfaction & communication)? By answering these questions, this study
      will provide valuable knowledge for VA researchers, clinicians, and policy makers. The study
      findings will have direct implications related to making specific recommendations regarding
      telemedicine utilization to deliver specialized mental health services for veterans suffering
      from PTSD.

      Project Background/Rationale: Post-Traumatic Stress Disorder (PTSD) is considered a major
      public health problem in the U.S. due to its high prevalence and high rates of disability
      associated with the disorder. For thousands of veterans, PTSD is a chronic disorder,
      resulting directly from military service that causes substantial psychological suffering and
      social disability. Barriers to PTSD care include poor access, mistrust, and lack of benefit
      from traditional treatments.

      However, recently developed evidenced based treatments like CPT are very effective.
      Unfortunately, these treatments are not widely available, as a large proportion of veterans
      live in rural communities and have poor access to specialized mental health care. The VA
      hospital system currently supports sophisticated telemedicine technology that can provide CPT
      to veterans in their home communities. The proposed project will assess the quality of CPT
      provided via telemedicine and its impact on outcomes, and is therefore, directly related to
      the VA's mission to provide advanced, accessible, and high quality health care to all
      eligible veterans regardless of place of residence: "Right care in the right place, at the
      right time".

      Project Objectives: The objective of the proposed study is to conduct a systematic comparison
      of PTSD outcomes for veterans receiving cognitive processing therapy via telemedicine vs.
      in-person care. The patient-therapist relationship is central in establishing an effective
      therapeutic relationship and is strongly influenced by communication. Consequently, this
      project will also compare provider-patient communication during telemedicine consultations
      vs. in-person consultations.

      Project Methods: We propose a randomized clinical trial of 254 patients receiving cognitive
      processing therapy either via telemedicine or by in-person care. Telemedicine visits will
      occur at La Jolla VA in San Diego and in-person visits will occur at the Mission Valley VA
      Clinic in San Diego. Veterans with PTSD will be enrolled from the primary care and mental
      health clinics at the above sites. Clinical services will be provided by 10 participating
      providers with specialized training in CPT. Therapy will be provided over 12 weekly sessions
      lasting 60 minutes each. Previously validated and widely used measures of PTSD symptom
      severity (Clinician-Administered PTSD Scale, PTSD Checklist ) and health related quality of
      life (SF-36) will be measured at baseline, at completion of therapy, and at 6 months
      follow-up. In addition, we will measure and compare the quality of verbal and non-verbal
      patient-provider communication for in-person and telemedicine visits via video recordings of
      visits, which will be analyzed using the Roter Interaction Analyses System. Patient and
      provider satisfaction will be measured post therapy with previously validated questionnaires.
      Statistical methods will include descriptive analyses, reliability analyses, and hypothesis
      testing using linear mixed models.
    

Intervention name(s): Telemedicine CBT; In-Person CBT
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Use of Videoconfrence Technology To Provide Cognitive Therapy; In-Person Provision Of Cognitive Therapy
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: PTSD; Telemedicine; Patient-Centered Care; Professional Patient Relationship; Psychotherapy; Cognitive Therapy