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

doi:10.1037/fsh0000623

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

Psychology

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

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 language	English
Pages (from-to)	198-211
Number of pages	14
Journal	Families, Systems and Health
Volume	39
Issue number	2
DOIs	https://doi.org/10.1037/fsh0000623
State	Published - 2021

Funding

This study was supported by a grant funded by the Veterans Affairs (VA) Quality Enhancement Research Initiative (SDP 09-402, PI: Felker). Jessica A. Chen is supported by a VA Health Services Research & Development (HSR&D) Career Development Award (IK2 HX002866). Katherine D. Hoerster was supported by a VA HSR&D Career Development Award (CDA 12-263) while the research was conducted. John C. Fortney is supported by a VA HSR&D Research Career Scientist Award. Additionally, we would like to thank Ms. Molly Silvestrini, Dr. Julia Whealin, Dr. Megan Dwight Johnson, our Translating Initiatives for Depression Into Effective Solutions Study posttraumatic stress disorder care managers, HSR&D statistical and chart abstraction staff, the members of our Expert Panel and Steering Committee, and our participating sites for their contributions to this project. The views expressed in this article are solely those of the authors and do not reflect an endorsement or the official policy or position of the Department of Veterans Affairs or the U.S. government

Funder number
IK2HX002866, SDP 09-402
CDA 12-263

Keywords

Care management
Collaborative care
Primary care
Ptsd
Veterans

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1037/fsh0000623

Cite this

Chen, J. A., Jakupcak, M., McCann, R., Fickel, J. J., Simons, C. E., Campbell, D. G., Stryczek, K. C., Hoerster, K. D., Chaney, E. F., Oishi, S. M., Miner, M. N., Bonner, L. M., Fortney, J. C., & Felker, B. L. (2021). Posttraumatic Stress Disorder Collaborative Care: A Quality Improvement Study in Veterans Affairs Primary Care. Families, Systems and Health, 39(2), 198-211. https://doi.org/10.1037/fsh0000623

@article{28127385b9684724bd3c7f6954ad4763,

title = "Posttraumatic Stress Disorder Collaborative Care: A Quality Improvement Study in Veterans Affairs Primary Care",

abstract = "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.",

keywords = "Care management, Collaborative care, Primary care, Ptsd, Veterans",

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

note = "Publisher Copyright: {\textcopyright} 2021 American Psychological Association",

year = "2021",

doi = "10.1037/fsh0000623",

language = "English",

volume = "39",

pages = "198--211",

journal = "Families, Systems and Health",

issn = "1091-7527",

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Chen, JA, Jakupcak, M, McCann, R, Fickel, JJ, Simons, CE, Campbell, DG, Stryczek, KC, Hoerster, KD, Chaney, EF, Oishi, SM, Miner, MN, Bonner, LM, Fortney, JC & Felker, BL 2021, 'Posttraumatic Stress Disorder Collaborative Care: A Quality Improvement Study in Veterans Affairs Primary Care', Families, Systems and Health, vol. 39, no. 2, pp. 198-211. https://doi.org/10.1037/fsh0000623

TY - JOUR

T1 - Posttraumatic Stress Disorder Collaborative Care

T2 - A Quality Improvement Study in Veterans Affairs Primary Care

AU - Chen, Jessica A.

AU - Jakupcak, Matthew

AU - McCann, Russell

AU - Fickel, Jacqueline J.

AU - Simons, Carol E.

AU - Campbell, Duncan G.

AU - Stryczek, Krysttel C.

AU - Hoerster, Katherine D.

AU - Chaney, Edmund F.

AU - Oishi, Sabine M.

AU - Miner, Mauri N.

AU - Bonner, Laura M.

AU - Fortney, John C.

AU - Felker, Bradford L.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - Care management

KW - Collaborative care

KW - Primary care

KW - Ptsd

KW - Veterans

UR - https://www.scopus.com/pages/publications/85114659425

U2 - 10.1037/fsh0000623

DO - 10.1037/fsh0000623

M3 - Article

C2 - 34410768

AN - SCOPUS:85114659425

SN - 1091-7527

VL - 39

SP - 198

EP - 211

JO - Families, Systems and Health

JF - Families, Systems and Health

IS - 2

ER -

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

Abstract

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Keywords

UN SDGs

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