TY - JOUR
T1 - A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients
AU - Possemato, Kyle
AU - Johnson, Emily
AU - Barrie, Kimberly
AU - Ghaus, Sharfun
AU - Noronha, Delilah
AU - Wade, Michael
AU - Greenbaum, Mark A.
AU - Rosen, Craig
AU - Cloitre, Marylene
AU - Owen, Jason
AU - Jain, Shaili
AU - Beehler, Gregory
AU - Prins, Annabel
AU - Seal, Karen
AU - Kuhn, Eric
N1 - Publisher Copyright:
© 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
PY - 2023/7
Y1 - 2023/7
N2 - Background: Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed. Objective: To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care. Design: Multi-site randomized pragmatic clinical trial. Participants: A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment. Intervention: CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the “PTSD Coach” mobile app. Four 30-min sessions encourage daily use of symptom management strategies. Main Measures: PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8 weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records. Key Results: Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D =.28, p =.021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p <.001). Conclusions: A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.
AB - Background: Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed. Objective: To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care. Design: Multi-site randomized pragmatic clinical trial. Participants: A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment. Intervention: CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the “PTSD Coach” mobile app. Four 30-min sessions encourage daily use of symptom management strategies. Main Measures: PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8 weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records. Key Results: Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D =.28, p =.021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p <.001). Conclusions: A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.
KW - mental health
KW - mHealth
KW - primary care
KW - PTSD
KW - Veterans
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U2 - 10.1007/s11606-023-08130-6
DO - 10.1007/s11606-023-08130-6
M3 - Article
C2 - 36932268
AN - SCOPUS:85150204263
SN - 0884-8734
VL - 38
SP - 905
EP - 912
JO - Journal of general internal medicine
JF - Journal of general internal medicine
ER -