Journal Article

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Green, Bonnie L, Meredith, Lisa S, Kaltman, Stacey, Cassells, Andrea, Hickey, Scot, Kurz, Jeremy R, Vaughan, Christine, Eisenman, David P, Sorbero, Melony, Diaz, Claudia, Tobin, Jonathan N, Wong, Eunice C, Zatzick, Douglas, Han, Bing

2016

Overview

BACKGROUNDThe effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs).OBJECTIVEWe compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM).DESIGNThis was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year.PARTICIPANTSWe recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18–65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD.MAIN MEASURESThe main outcomes were PTSD diagnosis and symptom severity (range, 0–136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months.KEY RESULTSPatients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement.CONCLUSIONSA minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.

• Publisher: Springer Nature B.V
• Subject: Anxiety / Clinical trials / Cognitive ability / Collaboration / Diagnosis / Drugs / Health care / Health problems / Internal medicine / Mental depression / Mental disorders / Mental health / Patients / Post traumatic stress disorder / Primary care / Quality assessment / Quality of life / Randomization