Posttraumatic Stress Disorder Collaborative Care: A Quality Improvement Study in Veterans Affairs Primary Care

Jessica A. Chen, Matthew Jakupcak, Russell McCann, Jacqueline J. Fickel, Carol E. Simons, Duncan G. Campbell, Krysttel C. Stryczek, Katherine D. Hoerster, Edmund F. Chaney, Sabine M. Oishi, Mauri N. Miner, Laura M. Bonner, John C. Fortney, Bradford L. Felker

Research output: Contribution to journalArticlepeer-review


Introduction: Collaborative care improves depression and anxiety outcomes. In this naturalistic, observational case study, we adapted an evidence-based depression collaborative care protocol for the assessment and treatment of posttraumatic stress disorder (PTSD) and sought to demonstrate that the protocol could be implemented in Veterans Affairs (VA) primary care. Method: Based on feedback from a content expert panel, clinical stakeholders, and a pilot study conducted in a postdeployment clinic, the original depression collaborative care protocol was modified to include PTSD assessment and support for PTSD medication adherence, self-management, and engagement in evidence-based PTSD care. Results: The modified program was implemented from November 2012 to March 2017, and 239 patients with PTSD were referred. Nearly two thirds (n = 185) enrolled, and they participated in the program for an average of 4 to 5 months and completed calls approximately once per month. Among patients with more than one assessment of clinical outcomes, 53.4% (n = 94) reported clinically significant improvement in depression on the Patient Health Questionnaire-9 (≥ 5-point decrease), and 42.2% (n = 35) reported clinically significant improvement on the PTSD Checklist (≥ 10-point decrease). Veterans and clinical staff described the modified collaborative care program positively in qualitative interviews. Discussion: Our findings suggest that a depression collaborative care program can be modified to support treatment of PTSD in primary care.

Original languageEnglish
Pages (from-to)198-211
Number of pages14
JournalFamilies, Systems and Health
Issue number2
StatePublished - 2021


  • Care management
  • Collaborative care
  • Primary care
  • Ptsd
  • Veterans


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