title: "Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?": Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals.
abstract: Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because 'dose received', that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Gilmore
authors.affiliation: Auburn University Department of Psychology, United States; VA Ann Arbor Health Care System, University of Michigan Department of Psychiatry, United States.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: Davis
authors.affiliation: Ralph H. Johnson Veterans Affairs Medical Center, United States.
authors.forename: Anouk
authors.initials: A
authors.lastname: Grubaugh
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States.
authors.forename: Heidi
authors.initials: H
authors.lastname: Resnick
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, United States; Ralph H. Johnson Veterans Affairs Medical Center, United States.
authors.forename: Anna
authors.initials: A
authors.lastname: Birks
authors.affiliation: Ralph H. Johnson Veterans Affairs Medical Center, United States.
authors.forename: Carol
authors.initials: C
authors.lastname: Denier
authors.affiliation: College of Nursing, Medical University of South Carolina, United States.
authors.forename: Wendy
authors.initials: W
authors.lastname: Muzzy
authors.affiliation: Ralph H. Johnson Veterans Affairs Medical Center, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Tuerk
authors.affiliation: Ralph H. Johnson Veterans Affairs Medical Center, United States; College of Nursing, Medical University of South Carolina, United States.
authors.forename: Ron
authors.initials: R
authors.lastname: Acierno
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006699:Home Care Services; D006787:Hospitals, Veterans; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D012742:Sex Offenses; D017406:Sexual Harassment; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
keywords: Clinical trial; Female veterans; Home-based telemedicine; Military sexual trauma; Posttraumatic stress disorder; Prolonged exposure