Advertisement

Use of Guideline-Recommended Treatments for PTSD Among Community-Based Providers in Texas and Vermont: Implications for the Veterans Choice Program

  • Erin P. FinleyEmail author
  • Michael Mader
  • Elizabeth K. Haro
  • Polly H. Noël
  • Nancy Bernardy
  • Craig S. Rosen
  • Mary Bollinger
  • Hector A. Garcia
  • Kathleen Sherrieb
  • Mary Jo V. Pugh
Article

Abstract

Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by the Department of Veterans Affairs (VA) in community settings. However, the quality of that care is unknown, particularly for complex conditions such as posttraumatic stress disorder (PTSD). A cross-sectional survey was conducted of 668 community primary care and mental health providers in Texas and Vermont to describe use of guideline-recommended treatments (GRTs) for PTSD. Relatively, few providers reported using guideline-recommended psychotherapy or prescribing practices. More than half of psychotherapists reported the use of at least one guideline-recommended psychotherapy for PTSD, but fewer reported the use of core treatment components, prior training in the GRT(s) they use, or adherence to a treatment manual. Suboptimal prescribing for PTSD patients was reported more commonly than optimal prescribing. Findings raise critical questions regarding how to ensure veterans seeking PTSD care in community settings receive psychotherapy and/or prescribing consistent with clinical practice guidelines.

Notes

Disclaimer

The views expressed are those of the authors and do not reflect the official views or policy of the Department of Veterans Affairs (VA) or US Government.

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding Information

We gratefully acknowledge funding received through the VA Quality Enhancement and Research Initiative (QUERI; PEC 15-243), in partnership with the VA Office of Analytics and Business Intelligence. We would like to extend special thanks to Dr. Amy Kilbourne and Dr. Joseph Francis for their support throughout the course of this work. During manuscript preparation, Dr. Finley was also supported by the VA-funded EMPOWER QUERI program (QUE 15-272).

References

  1. 1.
    Finley EP, Noël PH, Mader M, et al. Community clinicians and the veterans choice program for PTSD care: understanding provider interest during early implementation. Medical Care. 2017;55:S61-S70.CrossRefGoogle Scholar
  2. 2.
    The Management of Post-Traumatic Stress Working Group (2017) VA/DoD Clinical Practice Guidelines. VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress. U.S. Department of Veterans Affairs. Available online at https://www.healthquality.va.gov/guidelines/MH/ptsd/cpg_PTSD-full-201011612.PDF. Accessed 8 April 2018.
  3. 3.
    Karlin BE, Ruzek JI, Chard KM, et al. Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress. 2010;23(6):663–673.CrossRefGoogle Scholar
  4. 4.
    Rosen CS, Matthieu MM, Wiltsey Stirman S, et al. A Review of studies on the system-wide implementation of evidence-based psychotherapies for posttraumatic stress disorder in the Veterans Health Administration. Administration and Policy in Mental Health and Mental Health Services Research. 2016;43(6):957–977.CrossRefGoogle Scholar
  5. 5.
    Cook JM, Biyanova T, Elhai JD, et al. What do psychotherapists really do in practice? An Internet study of over 2,000 practitioners. Psychotherapy: Theory, Research, Practice, Training. 2010;47(2):260–267.CrossRefGoogle Scholar
  6. 6.
    Finley EP, Noël PH, Lee S, et al. Psychotherapy practices for veterans with PTSD among community-based providers in Texas. Psychological Services. 2017.  https://doi.org/10.1037/ser0000143.
  7. 7.
    Kilpatrick DG, Best CL, Smith DW, et al. (2011) Serving those who have served: educational needs of health care providers working with military members, veterans, and their families. U.S. Department of Veterans Affairs. Available online at https://www.hsrd.research.va.gov/for_researchers/Serving-Those-Who-Served.pdf. Accessed 8 April 2018.
  8. 8.
    Koblinsky SA, Leslie LA, Cook ET. Treating behavioral health conditions of OEF/OIF Veterans and their families: a state needs assessment of civilian providers. Military Behavioral Health. 2014;2(2):162–172.CrossRefGoogle Scholar
  9. 9.
    Tanielian T, Farris C, Epley C, et al. Ready to serve: community-based provider capacity to deliver culturally competent, quality mental health care to veterans and their families. Santa Monica, CA: RAND Corporation, 2014.Google Scholar
  10. 10.
    Richards LK, Bui E, Charney M, et al. Treating veterans and military families: evidence-based practices and training needs among community clinicians. Community Mental Health Journal. 2017;53(2):215–223.CrossRefGoogle Scholar
  11. 11.
    Stewart RE, Stirman SW, Chambliss DL. A qualitative investigation of practicing psychologists’ attitudes toward research-informed practice: implications for dissemination strategies. Professional Psychology: Research and Practice. 2012;43(2):100–109.CrossRefGoogle Scholar
  12. 12.
    Lewis CC, Marti CN, Marriott BR, et al. Patterns of practice in community mental health treatment of adult depression. Psychotherapy Research. 2017:1–8.  https://doi.org/10.1080/10503307.2017.1303210.
  13. 13.
    Wolitzky-Taylor K, Zimmermann M, Arch JJ, et al. Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings? Behaviour Research and Therapy. 2015;72:9–17.CrossRefGoogle Scholar
  14. 14.
    Watkins KE, Smith B, Akincigil A, et al. The quality of medication treatment for mental disorders in the department of veterans affairs and in private-sector plans. Psychiatric Services. 2016;67(4):391–396.CrossRefGoogle Scholar
  15. 15.
    Busch SH, Leslie DL, Rosenheck RA. Comparing the quality of antidepressant pharmacotherapy in the department of veterans affairs and the private sector. Psychiatric Services. 2004;55(12):1386–1391.CrossRefGoogle Scholar
  16. 16.
    Hassan AK, Farmer KC, Brahm NC, et al. Evaluating antidepressant treatment prior to adding second-line therapies among patients with treatment-resistant depression. International Journal of Clinical Pharmacy. 2016;38(2):429–437.CrossRefGoogle Scholar
  17. 17.
    Finley EP, Garcia HA, Ketchum NS, et al. Utilization of evidence-based psychotherapies in veterans affairs posttraumatic stress disorder outpatient clinics. Psychological Services. 2015;12(1):73–82.CrossRefGoogle Scholar
  18. 18.
    Becker CB, Zayfert C, Anderson E. A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy. 2004;42:277–292.CrossRefGoogle Scholar
  19. 19.
    Bernardy NC, Lund BC, Alexander B, et al. Prescribing trends in veterans with posttraumatic stress disorder. Journal of Clinical Psychiatry. 2012;73(3):297–303.CrossRefGoogle Scholar
  20. 20.
    Bernardy NC, Sherrieb K, Montano M. (2016) The use of technology to improve PTSD care in rural areas. Paper presented at the International Society of Traumatic Stress Studies Annual Meeting. Dallas, Texas, November 12, 2016.Google Scholar
  21. 21.
    Rosen CS, Chow HC, Finney JF, et al. VA practice patterns and practice guidelines for treating posttraumatic stress disorder. Journal of Traumatic Stress. 2004;17(3):213–222.CrossRefGoogle Scholar
  22. 22.
    Mowbray CT, Holter MC, Teague GB, et al. Fidelity criteria: development, measurement, and validation. The American Journal of Evaluation. 2003;24(3):315–340.CrossRefGoogle Scholar
  23. 23.
    Pankratz M, Hallfors D, Cho H. Measuring perceptions of innovation adoption: the diffusion of a federal drug prevention policy. Health Education Research. 2002;17(3):315–326.CrossRefGoogle Scholar
  24. 24.
    Lohr SL. Sampling: design and analysis (advanced series), second edition. Boston, MA: Duxbury Press, 2010.Google Scholar
  25. 25.
    Finley EP, Mader M, Bollinger MJ, et al. Characteristics associated with utilization of VA and non-VA care among Iraq and Afghanistan Veterans with post-traumatic stress disorder. Military Medicine. 2017;182(11):e1892-e1903.CrossRefGoogle Scholar
  26. 26.
    Hawley KM, Cook JR, Jensen-Doss A. Do noncontingent incentives increase survey response rates among mental health providers? A randomized trial comparison. Administration and Policy in Mental Health and Mental Health Services Research. 2009;36(5):343–348.CrossRefGoogle Scholar
  27. 27.
    Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Services Research. 2009;9(1):160.CrossRefGoogle Scholar

Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection [YEAR]  2018

Authors and Affiliations

  • Erin P. Finley
    • 1
    • 2
    Email author
  • Michael Mader
    • 2
  • Elizabeth K. Haro
    • 2
  • Polly H. Noël
    • 1
    • 2
  • Nancy Bernardy
    • 3
    • 4
  • Craig S. Rosen
    • 5
    • 6
  • Mary Bollinger
    • 1
    • 2
  • Hector A. Garcia
    • 2
    • 7
  • Kathleen Sherrieb
    • 3
    • 4
  • Mary Jo V. Pugh
    • 1
    • 2
  1. 1.South Texas Veterans Health Care SystemSan AntonioUSA
  2. 2.University of Texas Health Science Center at San AntonioSan AntonioUSA
  3. 3.VA National Center for PTSDWhite River JunctionUSA
  4. 4.Department of PsychiatryGeisel School of Medicine at DartmouthHanoverUSA
  5. 5.National Center for PTSD Dissemination and Training DivisionMenlo ParkUSA
  6. 6.Stanford University School of MedicineStanfordUSA
  7. 7.Valley Coastal Bend Veterans Health Care SystemHarlingonUSA

Personalised recommendations