This study will determine whether telephone support improves clinical outcomes of veterans who begin outpatient treatment for posttraumatic stress disorder. Participants will be randomly assigned to receive either usual care or usual care supplemented by biweekly monitoring and support by telephone during the first 3 months of treatment. Patients in both conditions will be compared on PTSD symptoms, engagement in treatment, violence and drinking at 4 months and 12 months after entering treatment.
This multisite randomized controlled trial will test whether a 3-month period of providing telephone monitoring to PTSD patients as a supplement to usual specialty mental health care improves 12-month clinical outcomes (a reduction in PTSD symptoms, violence, and substance use). Secondarily, this study will determine whether telephone monitoring promotes better engagement in outpatient treatment (Number of mental health and psychotherapy visits during the 3-month intervention period). Demand for VA PTSD treatment is increasing as troops return from combat deployments in Afghanistan and Iraq. Telemedicine is likely to be an important component in developing more effective and efficient models of PTSD care that improves patient functioning and treatment utilization. It is hoped that using telephone case monitoring as an inexpensive adjunct to standard care may improve clinical outcomes and reduce hospitalization among veterans with PTSD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
358
Outpatient mental health treatment as usual (normal case management, psychotherapy and/or pharmacotherapy) augmented by up to six fortnightly telephone monitoring and support calls from a case manager during the first three months of treatment.
Outpatient mental health treatment as usual (normal case management, psychotherapy and/or pharmacotherapy).
VA Palo Alto Health Care System (Meno Park Division)
Menlo Park, California, United States
Durham VA Medical Center
Durham, North Carolina, United States
VA Puget Sound Health Care System (American Lake)
Lakewood, Washington, United States
PTSD Checklist (PCL) Slope
Slope of improvement on the PTSD Checklist, a self-report measure of PTSD symptoms.
Time frame: 12 months
PTSD psychotherapy visits - intervention period
Number of psychotherapy visits for PTSD (psychotherapy procedure code + PTSD diagnosis code) completed during the 3 month intervention period.
Time frame: 3 months
Other mental health visits - intervention period
Number of "other" mental health visits (mental health visits without psychotherapy procedure code and/or without a PTSD diagnosis code) completed during the 3 month intervention period.
Time frame: 3 months
Depression slope
Slope of improvement on the Center for Epidemiological Studies Scale, a self-report measure of depression symptoms.
Time frame: 12 months
Alcohol problems slope
Slope of improvement on the Addiction Severity Index Alcohol Composite, a self-report measure of alcohol-related problems.
Time frame: 12 months
Drug problems slope
Slope of improvement on the Addiction Severity Index Drug Composite, a self-report measure of drug-related problems.
Time frame: 12 months
Aggression slope
Slope of improvement on a six-item self-report measure of aggressive behaviors, adapted from the Conflict Tactics Scale.
Time frame: 12 months
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Quality of Life slope
Slope of improvement on a self-report quality measure used in the Veterans Affairs Military Stress Treatment Assessment study.
Time frame: 12 months
PTSD psychotherapy visits -- follow-up period
Number of psychotherapy visits for PTSD (psychotherapy procedure code + PTSD diagnosis code) completed during the post-intervention period (months 4-12).
Time frame: months 4-12
Other mental health visits -- follow-up period
Number of "other" mental health visits (mental health visits without psychotherapy procedure code and/or without a PTSD diagnosis code) completed during the post-intervention period (months 4-12).
Time frame: months 4-12
Selective serotonin reuptake inhibitor refills (medication possession ratio)
Number of days' supply of selective serotonin reuptake inhibitors (SSRIs) obtained divided by 365 days.
Time frame: 12 months
Prazosin refills (medication possession ratio)
Number of days' supply of Prazosin obtained divided by 365 days.
Time frame: 12 months