title: Prescribing clinicians' perspectives on evidence-based psychotherapy for posttraumatic stress disorder.
abstract: Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training and dissemination. Yet VA continues to find EBP implementation difficult. Veterans with PTSD often initially present to prescribing clinicians, who then help make care decisions. It is therefore critical that these clinicians correctly screen and triage appropriate mental health care. The purpose of this study was to assess VA prescribing clinicians' knowledge, perceptions, and referral behaviors related to EBPs for PTSD and to identify facilitators and barriers to implementing EBPs within VA. We conducted qualitative interviews with 26 VA prescribing clinicians. Limited access to EBPs was the most commonly noted barrier. The clinicians we interviewed also held specific beliefs and behaviors that may delay or deter EBPs. Strategies to improve utilization also emerged. Findings suggest the need for increased access to EBPs, training to optimize the role of prescribing clinicians in helping Veterans with PTSD make appropriate care decisions, and specific organizational changes to facilitate access and effective referral systems for EBPs.
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA. Erin.R.Barnett@Dartmouth.edu.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Barnett
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA. Aaron.Jenkyn@va.gov.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Bernardy
authors.affiliation: National Center for Posttraumatic Stress Disorder, Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, USA. Aaron.Jenkyn@va.gov.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Jenkyn
authors.affiliation: Department of Management and Marketing, College of Management, University of Massachusetts, Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA. Louise.Parker@umb.edu.
authors.forename: Louise E
authors.initials: LE
authors.lastname: Parker
authors.affiliation: Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Mailstop 152, 601 Hwy 6 West, Iowa City, IA 52246, USA. Brian.Lund@va.gov.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
authors.affiliation: Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Mailstop 152, 601 Hwy 6 West, Iowa City, IA 52246, USA. Bruce.Alexander@va.gov.
authors.forename: Bruce
authors.initials: B
authors.lastname: Alexander
authors.affiliation: Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA. Aaron.Jenkyn@va.gov.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman