title: Utilization of evidence-based psychotherapies in Veterans Affairs posttraumatic stress disorder outpatient clinics.
abstract: In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of prolonged exposure (PE) and cognitive processing therapy (CPT) and to identify individual and organizational factors associated with treatment uptake and adherence. Participants (N = 128) completed an electronic survey assessing reported utilization of PE and CPT treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment. Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of PE and CPT were significantly associated with utilization of and adherence to those treatments. Reported number of hours conducting supportive care was positively associated with feeling the clinic was not sufficiently staffed (p = .05). Adherence to the PE treatment manual was positively associated with receiving emotional support from coworkers (p < .01). Provider attitudes and organizational factors such as staffing and work relationships may have an important impact on treatment selection and the quality of PTSD care provided in VA PCTs.
authors.affiliation: South Texas Veterans Health Care System.
authors.forename: Erin P
authors.identifier: 0000-0003-4497-7721
authors.initials: EP
authors.lastname: Finley
authors.affiliation: South Texas Veterans Health Care System.
authors.forename: Hector A
authors.initials: HA
authors.lastname: Garcia
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio.
authors.forename: Norma S
authors.initials: NS
authors.lastname: Ketchum
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio.
authors.forename: Donald D
authors.initials: DD
authors.lastname: McGeary
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio.
authors.forename: Cindy A
authors.initials: CA
authors.lastname: McGeary
authors.affiliation: Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System.
authors.forename: Shannon Wiltsey
authors.initials: SW
authors.lastname: Stirman
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000592:standards*; D000554:Ambulatory Care Facilities / Q000592:standards; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D011613:Psychotherapy / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*