Web and Shared Decision Making for Reserve/National Guard Women's PTSD Care
Condition: PTSD
MeSH terms: Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Women and Reserve/National (RNG) Veterans are among the fastest growing groups of new VA
      users. While PTSD is prevalent in this group, most women don't access or complete needed
      treatment. This study will investigate Operation enduring/Iraqi Freedom and New Dawn
      (OEF/OIF/OND) RNG female war Veterans' perceptions, preferences, barriers and facilitators to
      accessing VA mental health (MH) and evidence-based PTSD psychotherapy. This information will
      be used to revise an existing web-based screen that educates participants about their unique
      post-deployment MH conditions. This web-interface will then be used to randomly assign women
      who screen positive for PTSD to either 1) a concierge nurse case manager who uses shared
      decision-making to engage Veterans in EBP or 2) usual outreach to determine what engagement
      approach women prefer. The investigators' findings will provide VA leaders with key
      information to understand and improve access to RNG PTSD treatment.
    

Detailed description: 
      Women and OEF/OIF/OND Reserve/National Guard (RNG) war Veterans are among the fastest growing
      groups of new VA users. Although PTSD is highly prevalent in this group of Veterans, most
      choose not to seek care for a variety of reasons. Facilitating access to mental health (MH)
      services for RNG OEF/OIF/OND female Veterans with post-traumatic stress disorder (PTSD) is
      challenging and requires new approaches to outreach. Such approaches are urgently needed to
      mediate the severity of post-deployment MH conditions, alleviate concerns over MH diagnoses,
      and interrupt the cycle of chronicity found in many with PTSD. This gap between need for and
      use of VA PTSD services suggests that further research is needed to understand specific
      barriers to VA mental health (MH) care and VA PTSD evidence-based psychotherapy (EBP). A
      web-based interface tailored to consumer needs has the potential to promote active engagement
      by Veterans in their health care. Considering that OEF/OIF combat Veterans enrolled in VA
      care report a preference to seek readjustment services or information over the internet, such
      an approach may have important advantages for engaging this group. Furthermore, evidence
      indicates that when patients are educated about their physical health conditions and
      treatment alternatives, shared decision-making results in increased treatment participation,
      better adherence to treatment recommendations, and better health outcomes. Although highly
      promising, web-based and shared-decision making approaches to facilitating VA MH treatment
      utilization are in need of further study.

      In Phase 1 of the project, the investigators will use qualitative methods to assess VA
      enrolled PTSD positive OEF/OIF/OND RNG female war Veterans' perceptions, preferences and
      barriers and facilitators to accessing VA MH services and evidence based psychotherapy (EBP)
      for PTSD. This information will be used to refine the investigators' existing web-based
      interface to better address these issues. Satisfaction with the revised interface will then
      be assessed. Phase 2 will focus on comparing the efficacy of two approaches to promoting VHA
      initiation. Participants who screen positive for PTSD on the web interface will be randomly
      assigned to: 1) Study concierge nurse case manager (NCM) facilitated shared decision making
      to assist with VA MH evaluation and treatment; or 2) existing outreach (current standard of
      care). Follow-up assessments will be conducted at 6 and 12 months to determine whether and
      where participants sought MH care (from both VA and non-VA resources).

      This study will provide valuable insights about this population's perceptions of VA MH
      services and of PTSD EBP, as well as their evolving use of VA and other community resources
      to address PTSD and other post-deployment MH needs. Furthermore, it will provide important
      information regarding the efficacy of relatively inexpensive and resource-sparing
      interventions that can be readily implemented within existing and emerging (e.g., Patient
      Alight Care Teams [PACT]) models of VA care delivery. While the proposed web interface and
      shared decision-making intervention are currently directed at RNG women Veterans
      post-deployment, there are clear implications for expansion to other populations and
      health/MH concerns, as well. Findings have important policy implications for several
      operational partners heavily invested in the improved access and delivery of evidence-based
      mental health care for Veterans with PTSD.
    

Intervention name(s): Nurse Care Manager (NCM)
Intervention type(s): Behavioral
Intervention description(s): Nurse care manager interventions with telephone implemented shared decision making protocol compared to outreach as usual OEF/OIF/OND outreach.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Women; Veterans; PTSD; Access to Care; Shared Decision Making