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Telemedicine Outreach for PTSD in Department of Veterans Affairs Community Based Outpatient Clinics

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.

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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.

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