title: Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial.
abstract: BACKGROUND
  The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs).
  
  
  OBJECTIVE
  We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM).
  
  
  METHODS
  This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year.
  
  
  METHODS
  We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD.
  
  
  METHODS
  The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months.
  
  
  RESULTS
  Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7% for PCM patients and 60.6% for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14% higher (p < 0.01) and mental health medication prescription rates that were 15.2% higher (p < 0.01) than patients with no engagement.
  
  
  CONCLUSIONS
  A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA. lisa_meredith@rand.org.|VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Sepulveda, CA, USA. lisa_meredith@rand.org.
authors: Lisa S
authors: LS
authors: Meredith
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.|Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors: David P
authors: DP
authors: Eisenman
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
authors: Bing
authors: B
authors: Han
authors: Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA.
authors: Bonnie L
authors: BL
authors: Green
authors: Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA.
authors: Stacey
authors: S
authors: Kaltman
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
authors: Eunice C
authors: EC
authors: Wong
authors: RAND Corporation, Pittsburgh, PA, USA.
authors: Melony
authors: M
authors: Sorbero
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
authors: Christine
authors: C
authors: Vaughan
authors: Clinical Directors Network (CDN), New York, NY, USA.
authors: Andrea
authors: A
authors: Cassells
authors: Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, School of Medicine, University of Washington, Seattle, WA, USA.
authors: Douglas
authors: D
authors: Zatzick
authors: University of New Mexico, Albuquerque, NM, USA.
authors: Claudia
authors: C
authors: Diaz
authors: RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
authors: Scot
authors: S
authors: Hickey
authors: U.S. Air Force, Esther, FL, USA.
authors: Jeremy R
authors: JR
authors: Kurz
authors: Clinical Directors Network (CDN), New York, NY, USA.|Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA.|Center for Clinical & Translational Science, The Rockefeller University, New York, NY, USA.
authors: Jonathan N
authors: JN
authors: Tobin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009515:New Jersey; D009518:New York; D010348:Patient Care Team / Q000458:organization & administration; D010352:Patient Dropouts / Q000706:statistics & numerical data; D018579:Patient Selection; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration; D011788:Quality of Life; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult
keywords: PTSD; community based interventions; medicaid; mental health; primary care