title: Predictors of Initiation and Engagement of Cognitive Processing Therapy Among Veterans With PTSD Enrolled in Collaborative Care.
abstract: Collaborative care (CC) increases access to evidence-based pharmacotherapy and psychotherapy. The study aim was to identify the characteristics of rural veterans receiving a telemedicine-based CC intervention for posttraumatic stress disorder (PTSD) who initiated and engaged in cognitive processing therapy (CPT) delivered via interactive video. Veterans diagnosed with PTSD were recruited from 11 community-based outpatient clinics (N = 133). Chart abstraction identified all mental health encounters received during the 12-month study. General linear mixed models were used to identify characteristics that predicted CPT initiation and engagement (attendance at 8 or more sessions). For initiation, higher PTSD severity according to the Clinician Administered PTSD Scale (d = -0.39, p = .038) and opt-out recruitment (vs. self-referral; d = -0.49, p = .010) were negative predictors. For engagement, major depression (d = -1.32, p = .006) was a negative predictor whereas a pending claim for military service connected disability (d = 2.02, p = .008) was a positive predictor. In general, veterans enrolled in CC initiated and engaged in CPT at higher rates than usual care. Those with more severe symptoms and comorbidity, however, were at risk of not starting or completing CPT.
authors.affiliation: Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Grubbs
authors.affiliation: Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA.|Division of Population Health, Department of Psychiatry, University of Washington, Seattle, Washington, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.affiliation: Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.affiliation: Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Hudson
authors.affiliation: Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA.
authors.forename: William Mark
authors.initials: WM
authors.lastname: Moore
authors.affiliation: Department of Psychology, VA Loma Linda Health Care System, Loma Linda, California, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Custer
authors.affiliation: Department of Psychology, Overton Brooks VA Medical Center, Shreveport, Louisiana, USA.|Department of Psychiatry, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Schneider
authors.affiliation: National Center for PTSD, VA Medical Center, White River Junction, Vermont, USA.|Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
authors.forename: Paula P
authors.initials: PP
authors.lastname: Schnurr
mesh_terms: D001499:Bayes Theorem; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology*