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VA QUERI Collaboration: Reaching Out to Rural Veterans with PTSD

February 21, 2018

Of those Veterans diagnosed with PTSD, 40% live in rural settings – and two-thirds live closer to one of VA’s community-based outpatient clinics (CBOCs) than to a VA medical center. An article in VA’s Research Currents highlights collaboration between VA’s Office of Rural Health and the Quality Enhancement Research Initiative (QUERI) in implementing the Telemedicine Outreach for PTSD (TOP) program.

Led by John Fortney, PhD, principal investigator for HSR&D’s Virtual Specialty Care QUERI Program, this collaboration will work to implement the TOP program in 12 CBOCs across six VA medical centers. Dr. Fortney explains that the “… focus [of the program] is on improving access to mental healthcare for Veterans living in rural areas. Because of the avoidance symptoms associated with PTSD, long travel distances to urban areas can be a major barrier to care for rural Veterans.” Providing psychotherapy in a primary care setting or at home also helps reduce the negative impacts from stigma. “Stigmatization occurs when the public labels people with PTSD and attaches negative stereotypes to them,” said Dr. Fortney. “Public stigma can lead to prejudicial attitudes and discriminatory behaviors. Public stigma can also lead to self-stigma, whereby those being stigmatized internalize the views of the public. The expectation of rejection by others and lack of self-esteem often leads to avoidance of seeking help.”

Veterans in the TOP program will receive frequent phone calls from a care manager who helps them get access to services provided by off-site psychiatrists and psychologists. The psychotherapy is delivered via interactive video from a VA medical center to a CBOC or to the Veteran’s home. The telephone care manager also monitors the progress of the Veterans and helps them overcome barriers to care. Thus far, Dr. Fortney and his colleagues have enrolled more than 500 Veterans with PTSD, who are not receiving specialty PTSD care, in the TOP pilot program.

Prior VA studies have shown that the remote delivery of psychotherapy for Veterans with PTSD can have positive effects. For example, Dr. Fortney led a randomized trial involving rural Veterans that appeared in JAMA Psychiatry and showed that telemedicine-based collaborative care can successfully engage Veterans living in rural settings in evidence-based psychotherapy to improve PTSD outcomes.

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