Re-Engineering Systems for the Primary Care Treatment for PTSD

Study Overview
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Brief Summary
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The study is an evaluation of a systemic intervention to enhance the delivery of care according to practice guidelines for posttraumatic stress disorder (PTSD). The immediate objectives are to (1) implement three component model (3CM) in VA primary care clinics; and (2) evaluate the effects of 3CM on clinician behavior and patient outcomes. The long-term objectives are to generate information to support implementation research on the RESPECT model for treating PTSD in primary care and ultimately, the implementation of the model in VHA to provide care to veterans with PTSD.

Detailed Description
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3CM consists of (1) a prepared practice, (2) care management, and (3) enhanced mental health support. A prepared practice refers to education for primary care clinicians and office staff about practice guidelines and evidence-based care, the skills needed for use of assessment measures, and the use of communication forms and routines. The education plan consists of predisposing activities, including active teaching and learning, and enabling and reinforcing activities in order to help clinicians use newly acquired skills and to reinforce the continued use of these skills in practice. Care management is accomplished by telephone, usually by a centrally located care manager during acute phase treatment and follow up to answer patient questions, promote adherence to the clinician's management plan, and help patients overcome barriers to adherence. Enhanced mental health support is provided by a psychiatrist who supervises care managers by telephone, provides informal consultation to primary care clinicians, and helps to increase the quantity or quality of mental health referral resources.

Official Title
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Reengineering Systems for the Primary Care Treatment of PTSD

Conditions
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Stress Disorders, Posttraumatic, Depression

Intervention / Treatment
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* Behavioral: Three Component Model of Collaborative Care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Military Veterans in Primary Care Clinics who meet diagnostic criteria for PTSD in one of the 5 sites in Texas where this study is being conducted. Must have regular access to a telephone and speak English. Exclusion Criteria: Cognitive impairment A history of psychosis or mania Prominent current suicidal ideation Current substance dependence Current engagement in mental health treatment

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Three Component Model<br>Three Component Model of Collaborative Care: Patients randomized to 3CM will receive telephone care management along with usual care by VA clinicians. | Behavioral: Three Component Model of Collaborative Care<br>* Patients randomized to 3CM will receive telephone care management along with usual care by VA clinicians.<br>|
| No Intervention: Usual Care<br>Patients randomized to Usual Care will receive care as usual by VA clinicians. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PTSD Symptom Severity | PTSD Symptom Severity was measured using the Postraumatic Diagnostic Scale (PDS) | 3 and 6 months after initial assessment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depression | Measure using the Hopkins Symptom Checklist-20 | 3 and 6 months after initial assessment | 
| SF-36 Mental Component |  | 3 and 6 months after initial assessment | 
| SF-36 Physical Component |  | 3 and 6 months after initial assessment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stress Disorders, Posttraumatic, Delivery of Health Care, Integrated, Primary Health Care, Veterans, Depression