For rural veterans with PTSD, telemedicine may help

For the many veterans with post-traumatic stress disorder (PTSD) who don’t have access to a trained mental health care team, connecting with such a team remotely by phone and video chats may help, a new study suggests.

At least 500,000 veterans in the Veterans Health Administration (VHA) system, or nearly 10 percent of the VHA population, were diagnosed with PTSD in 2012, the researchers write in JAMA Psychiatry.

Previous studies have found that PTSD treatments delivered by interactive video are equivalent to therapy given in person, according to lead author John Fortney of the VA Puget Sound Health Care System in Seattle, Washington.

“PTSD services are available to all Veterans enrolled in the VA, but each veteran’s perceptions about their access to care can depend on many factors,” Fortney told Reuters Health by email.

“We know that 38 percent of VA patients diagnosed with PTSD live in rural areas, and that two thirds live closer to one of VA’s 825 Community Based Outpatient Clinics than to a large Medical Center (VAMC), which underscores the importance of striving to provide the highest quality PTSD care in these clinics,” he said.

For the new study, researchers included 265 middle-aged vets with severe PTSD symptoms at one of the outpatient clinics without onsite psychiatrists or psychologists from 2009 through 2011. Patients were recruited from Shreveport, Louisiana, Little Rock, Arkansas and Loma Linda, California.

Half received the outpatient clinic’s ordinary care, and the other half were connected to an additional care team at a larger medical center via telemedicine, including nursing care managers and pharmacists calling their homes and psychiatrists providing consultations by video-chat at the outpatient clinic. The psychiatrists then gave feedback and treatment recommendations to providers at the clinic through electronic medical records.

Psychologists delivered cognitive processing therapy, a specific behavioral therapy developed to treat PTSD, by video chat.

During the study, more than half of the telemedicine group received cognitive processing therapy, compared to 12 percent of the comparison group.

Patients in the telemedicine group had bigger decreases in Posttraumatic Diagnostic Scale scores at the six and 12-month mark than the comparison group, according to the authors.

There was no difference in medicines prescribed or taken between the two groups, the authors write.

“Dr. Fortney’s intervention developed a method to extend the reach of the specialized PTSD services to the community primary care clinics by using telehealth technology,” said Michele Spoont, Health Psychologist in the Minneapolis VA Health Care System and assistant professor in the Departments of Psychiatry and Psychology at the University of Minnesota.

“Not only does it make it easier for veterans to get the specialized treatments, but maybe it will help those veterans who are hesitant to go to a mental health program get evidence-based PTSD treatment if it is offered in a primary care setting,” Spoont told Reuters Health by email.

She was not involved in the new research.

Veterans should seek mental health care if they experience irritability or anger problems, depression, anxiety, insomnia, nightmares or unwanted memories about traumatic experiences, or if they’re self-medicating with alcohol or drugs, having difficulty doing normal day-to-day activities because of emotional problems or difficulty concentrating, uncharacteristic conflict with family or friends, or having suicidal or violent thoughts or impulses, Spoont said.

“Any VA primary care provider can help them get connected with mental health services,” she said. “They can also call their local VA or go on the VA website to find locations near them for access to mental health services.” (www.va.gov/)

Not all patients are comfortable with interactive video technology, but the vast majority of patients are highly satisfied receiving psychiatric and psychological services via interactive video, Fortney said.

“Many components of the telemedicine-based collaborative care model are currently available in the VA, including care manager programs, telepsychiatry, and in person Cognitive Processing Therapy,” Fortney said. “However, it is not common to see the delivery of Cognitive Processing Therapy combined with the other components of the telemedicine-based collaborative care model.”

It would be feasible to implement this telemedicine strategy in the VA, but more research first needs to identify the strategies that would need to be put into place in order to promote the widespread adoption of this particular model of care, he said.