Craig S Rosen1, Kathryn J Azevedo1, Quyen Q Tiet1, Carolyn J Greene1, Amanda E Wood1, Patrick Calhoun1, Thomas Bowe1, Bruce P Capehart1, Eric F Crawford1, Mark A Greenbaum1, Alex H S Harris1, Michael Hertzberg1, Steven E Lindley1, Brandy N Smith1, Paula P Schnurr1. 1. Dr. Rosen, Dr. Azevedo, Dr. Tiet, and Ms. Smith are with the National Center for PTSD Dissemination and Training Division, Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California (e-mail: craig.rosen@va.gov ). Dr. Rosen and Dr. Tiet are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, where Dr. Lindley is affiliated. Dr. Lindley is also with the VA Palo Alto Health Care System, Menlo Park. Dr. Azevedo is also with the Center for Innovation to Implementation, Health Services Research and Development Service, VA Palo Alto Health Care System, Menlo Park, where Dr. Bowe and Dr. Harris are affiliated. Dr. Harris is also with the Department of Surgery, Stanford University School of Medicine, Stanford. Dr. Greene is with the VA Office of Mental Health Services, Menlo Park. Dr. Wood is with Mental Health Services American Lake Division, VA Puget Sound Health Care System, Tacoma, Washington. Dr. Calhoun is with the VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC). Dr. Capehart and Dr. Hertzberg are with the Department of Psychiatry, Durham VA Medical Center, Durham, North Carolina. Dr. Calhoun, Dr. Capehart, and Dr. Hertzberg are also with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham. Dr. Crawford, formerly with the Clinical Core, Mid-Atlantic Region MIRECC, Durham, is now with the Sheridan VA Medical Center, Sheridan, Wyoming. Mr. Greenbaum is with the VA Sierra-Pacific MIRECC, Menlo Park. Dr. Schnurr is with the National Center for PTSD Executive Division, White River Junction VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
Abstract
OBJECTIVE: This study assessed whether adding telephone care management to usual outpatient mental health care improved treatment attendance, medication compliance, and clinical outcomes of veterans with posttraumatic stress disorder (PTSD). METHODS: In a multisite randomized controlled trial, 358 veterans were assigned to either usual outpatient mental health treatment (N=165) or usual care plus twice-a-month telephone care management (TCM) and support in the first three months of treatment (N=193). Treatment utilization and medication refills were determined from U.S. Department of Veterans Affairs administrative data. PTSD, depression, quality of life, aggressive behavior, and substance use were assessed with self-report questionnaires at intake, four months, and 12 months. RESULTS: Telephone care managers reached 95% of TCM participants (N=182), completing an average 5.1 of 6.0 planned telephone calls. During the three-month intervention period, TCM participants completed 43% more mental health visits (M±SD=5.9±6.8) than did those in usual care (4.1±4.2) (incident rate ratio=1.36, χ2=6.56, df=1, p<.01). Treatment visits in the nine-month follow-up period and medication refills did not differ by condition. Only 9% of participants were scheduled to receive evidence-based psychotherapy. Slopes of improvement in PTSD, depression, alcohol misuse, drug problems, aggressive behavior, and quality of life did not differ by condition or treatment attendance. CONCLUSIONS:TCM improved PTSD patients' treatment attendance but not their outcomes. TCM can enhance treatment engagement, but outcomes depend on the effectiveness of the treatments that patients receive.
RCT Entities:
OBJECTIVE: This study assessed whether adding telephone care management to usual outpatient mental health care improved treatment attendance, medication compliance, and clinical outcomes of veterans with posttraumatic stress disorder (PTSD). METHODS: In a multisite randomized controlled trial, 358 veterans were assigned to either usual outpatient mental health treatment (N=165) or usual care plus twice-a-month telephone care management (TCM) and support in the first three months of treatment (N=193). Treatment utilization and medication refills were determined from U.S. Department of Veterans Affairs administrative data. PTSD, depression, quality of life, aggressive behavior, and substance use were assessed with self-report questionnaires at intake, four months, and 12 months. RESULTS: Telephone care managers reached 95% of TCM participants (N=182), completing an average 5.1 of 6.0 planned telephone calls. During the three-month intervention period, TCM participants completed 43% more mental health visits (M±SD=5.9±6.8) than did those in usual care (4.1±4.2) (incident rate ratio=1.36, χ2=6.56, df=1, p<.01). Treatment visits in the nine-month follow-up period and medication refills did not differ by condition. Only 9% of participants were scheduled to receive evidence-based psychotherapy. Slopes of improvement in PTSD, depression, alcohol misuse, drug problems, aggressive behavior, and quality of life did not differ by condition or treatment attendance. CONCLUSIONS: TCM improved PTSDpatients' treatment attendance but not their outcomes. TCM can enhance treatment engagement, but outcomes depend on the effectiveness of the treatments that patients receive.
Authors: Jackson M Steinkamp; Nathaniel Goldblatt; Jacob T Borodovsky; Amy LaVertu; Ian M Kronish; Lisa A Marsch; Zev Schuman-Olivier Journal: JMIR Ment Health Date: 2019-03-12