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Enhancing Access to Psychiatric Care for Posttraumatic Stress Disorder in Veterans with Mild Traumatic Brain Injury through Integrated Services

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Abstract

(i) To describe an integrated model of psychiatric care for the treatment of posttraumatic stress disorder (PTSD) in veterans with mild traumatic brain injury (mTBI). (ii) To evaluate access to and engagement in psychiatric care among veterans with comorbid PTSD and mTBI after implementation of an Integrated Care (IC) model compared to the previous Usual Care (UC). 100 randomly selected charts, 50 from each of UC and IC were reviewed in this non-concurrent case- control study. Polytrauma Network Site (PNS), an outpatient rehabilitation clinic, for veterans who suffered from brain and other traumatic injuries at an urban VA Polytrauma Rehabilitation Center. Veterans receiving treatment for mTBI symptoms by the rehabilitation team were referred for medication management for PTSD to UC and IC. Co-located access to psychiatric care for medication management as part of the interdisciplinary team with the goal of expediting rehabilitation and functional recovery. Number of consults for psychiatric care for medication management scheduled and completed within 30 days, and number of veterans offered, initiating, and completing evidence-based psychotherapies for PTSD in UC compared to IC. After implementation of IC there were significant improvements in timely completion of consults and patient engagement with a psychiatrist. There also were improvements in number of referrals, initiation, and completion of evidence-based psychotherapies for the treatment of PTSD. IC within the PNS shows promise as an effective care model for increasing access and engagement in care for veterans with comorbid PTSD/mTBI. Future research is needed to examine the utility of this model in other sites.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We thank Eric A. Townsend and Edward A. Martinez for their help with accessing the data from electronic medical records. Dr. Baig’s salary was supported by the Department of Veterans Affairs.

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Authors and Affiliations

  1. Mental Health, South Texas Veterans Healthcare System, Mail Code A116, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA

    Muhammad R. Baig & Adeel Meraj

  2. Polytrauma Rehabilitation Center, Mail Code A116, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA

    Muhammad R. Baig & Rebecca N. Tapia

  3. Department of Psychiatry, University of Texas Health Science Center at San Antonio, Mail Code A116, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA

    Muhammad R. Baig, John D. Roache & Erin P. Finley

  4. South Texas Veterans Health Care System, San Antonio, TX, USA

    Jacqueline A. Pugh & Erin P. Finley

  5. Division of General/Hospital Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Jacqueline A. Pugh & Erin P. Finley

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  1. Muhammad R. Baig
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  2. Rebecca N. Tapia
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Correspondence to Muhammad R. Baig.

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Ethical Approval

The review of patients’ charts were in accordance with the ethical standards of the Institutional Review Board (IRB) of the University of Texas Health Science Center at San Antonio (UTHSCSA) and STVHCS Research and Development Committee with the 1964 Helsinki declaration and its later amendments.

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The authors declare that they have no conflict of interest.

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Informed consent from individual participants is not required for the retrospective chart review as no identifying information about participants is available in the article.

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Baig, M.R., Tapia, R.N., Meraj, A. et al. Enhancing Access to Psychiatric Care for Posttraumatic Stress Disorder in Veterans with Mild Traumatic Brain Injury through Integrated Services. Psychiatr Q 90, 815–827 (2019). https://doi.org/10.1007/s11126-019-09668-7

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  • DOI: https://doi.org/10.1007/s11126-019-09668-7

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