title: RESPECT-PTSD: re-engineering systems for the primary care treatment of PTSD, a randomized controlled trial.
abstract: BACKGROUND
  Although collaborative care is effective for treating depression and other mental disorders in primary care, there have been no randomized trials of collaborative care specifically for patients with Posttraumatic stress disorder (PTSD).
  
  
  OBJECTIVE
  To compare a collaborative approach, the Three Component Model (3CM), with usual care for treating PTSD in primary care.
  
  
  METHODS
  The study was a two-arm, parallel randomized clinical trial. PTSD patients were recruited from five primary care clinics at four Veterans Affairs healthcare facilities and randomized to receive usual care or usual care plus 3CM. Blinded assessors collected data at baseline and 3-month and 6-month follow-up.
  
  
  METHODS
  Participants were 195 Veterans. Their average age was 45 years, 91% were male, 58% were white, 40% served in Iraq or Afghanistan, and 42% served in Vietnam.
  
  
  METHODS
  All participants received usual care. Participants assigned to 3CM also received telephone care management. Care managers received supervision from a psychiatrist.
  
  
  METHODS
  PTSD symptom severity was the primary outcome. Depression, functioning, perceived quality of care, utilization, and costs were secondary outcomes.
  
  
  RESULTS
  There were no differences between 3CM and usual care in symptoms or functioning. Participants assigned to 3CM were more likely to have a mental health visit, fill an antidepressant prescription, and have adequate antidepressant refills. 3CM participants also had more mental health visits and higher outpatient pharmacy costs.
  
  
  CONCLUSIONS
  Results suggest the need for careful examination of the way that collaborative care models are implemented for treating PTSD, and for additional supports to encourage primary care providers to manage PTSD.
authors.affiliation: National Center for PTSD, VAMC, White River Junction, VT 05009, USA. paula.schnurr@dartmouth.edu
authors.forename: Paula P
authors.initials: PP
authors.lastname: Schnurr
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Oxman
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Dietrich
authors.forename: Mark W
authors.initials: MW
authors.lastname: Smith
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Forshay
authors.forename: Jiang
authors.initials: J
authors.lastname: Gui
authors.forename: Veronica
authors.initials: V
authors.lastname: Thurston
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D013313:Stress Disorders, Post-Traumatic / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology