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Fortney JC, Pyne JM, Kimbrell T, Hudson TJ. Telemedicine Outreach for PTSD in Department of Veterans Affairs Community Based Outpatient Clinics. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2010 Nov 4; Montréal, Canada.
The 12-month prevalence rate of PTSD is nearly twice that of depression among veterans treated in VA primary care clinics (11.5%). Although psychotherapy and pharmacotherapy treatments for PTSD have been proven efficacious in controlled trials, geographic barriers often prevent veterans from accessing these evidence-based treatments. The objective of this randomized effectiveness study is to evaluate a telemedicine based collaborative care model designed to improve PTSD outcomes among veterans treated in fourteen VA Community Based Outpatient Clinics (CBOCs) lacking on-site psychiatrists. While most parent VAMCs offer specialized PTSD programs, CBOCs are often unable to hire on-site psychiatrists or other mental health specialists with PTSD expertise. This is especially true for small CBOCs in rural areas, where a large proportion of Operation Iraqi Freedom and Operation Enduring Freedom veterans are seeking care. In the telemedicine based collaborative care model, an off-site PTSD care team uses telemedicine technologies to collaborate with CBOC providers. The off-site PTSD care team includes: nurse care mangers, pharmacist medication managers, psychologists (delivering cognitive processing therapy), and consultation psychiatrists. Telemedicine technologies include telephone, interactive video, shared electronic medical record, and web-based decision support system. The collaborating CBOC providers include on-site primary care providers and social workers, and off-site tele-psychiatrists.