title: A pilot trial of telephone-based collaborative care management for PTSD among Iraq/Afghanistan war veterans.
abstract: BACKGROUND
  Collaborative care and care management are cornerstones of Primary Care-Mental Health Integration (PC-MHI) and have been shown to reduce depressive symptoms. Historically, the standard of Veterans Affairs (VA) collaborative care was referring patients with posttraumatic stress disorder (PTSD) to specialty care. Although referral to evidence-based specialty care is ideal, many veterans with PTSD do not receive such care. To address this issue and reduce barriers to care, VA currently recommends veterans with PTSD be offered treatment within PC-MHI as an alternative. The current project outlines a pilot implementation of an established telephone-based collaborative care model-Translating Initiatives for Depression into Effective Solutions (TIDES)-adapted for Iraq/Afghanistan War veterans with PTSD symptoms (TIDES/PTSD) seen in a postdeployment primary care clinic.
  
  
  METHODS
  Structured medical record extraction and qualitative data collection procedures were used to evaluate acceptability, feasibility, and outcomes.
  
  
  RESULTS
  Most participants (n=17) were male (94.1%) and white (70.6%). Average age was 31.2 (standard deviation=6.4) years. TIDES/PTSD was successfully implemented within PC-MHI and was acceptable to patients and staff. Additionally, the total number of care manager calls was positively correlated with number of psychiatry visits (r=0.63, p<0.05) and amount of reduction in PTSD symptoms (r=0.66, p<0.05). Overall, participants in the pilot reported a significant reduction in PTSD symptoms over the course of the treatment (t=2.87, p=0.01).
  
  
  CONCLUSIONS
  TIDES can be successfully adapted and implemented for use among Iraq/Afghanistan veterans with PTSD. Further work is needed to test the effectiveness and implementation of this model in other sites and among veterans of other eras.
authors.affiliation: 1 Seattle Division, Mental Health Service, VA Puget Sound Healthcare System , Seattle, Washington.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Hoerster
authors.forename: Matthew
authors.initials: M
authors.lastname: Jakupcak
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Stephenson
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Fickel
authors.forename: Carol E
authors.initials: CE
authors.lastname: Simons
authors.forename: Ashley
authors.initials: A
authors.lastname: Hedeen
authors.forename: Megan
authors.initials: M
authors.lastname: Dwight-Johnson
authors.forename: Julia M
authors.initials: JM
authors.lastname: Whealin
authors.forename: Edmund
authors.initials: E
authors.lastname: Chaney
authors.forename: Bradford L
authors.initials: BL
authors.lastname: Felker
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003299:Cooperative Behavior; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration*; D019114:Remote Consultation / Q000458:organization & administration*; D012648:Self Care; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D013689:Telephone; D014481:United States; D014728:Veterans
chemical_list: D014150:Antipsychotic Agents
keywords: collaborative care; posttraumatic stress disorder; primary care mental health; veterans