title: Maintenance and Reach of Exposure Psychotherapy for Posttraumatic Stress Disorder 18 Months After Training.
abstract: This study examined aspects of clinicians' work environment that facilitated sustained use of prolonged exposure (PE) therapy. Surveys were completed by 566 U.S. Department of Veterans Affairs clinicians 6 and 18 months after intensive training in PE. The number of patients treated with PE at 18 months (reach) was modeled as a function of clinician demographics, clinician beliefs about PE, and work context factors. There were 342 clinicians (60.4%) who used PE at 6 and 18 months after training, 58 (10.2%) who used PE at 18 but not 6 months, 95 (16.7%) who used PE at 6 but not 18 months, and 71 (12.5%) who never adopted PE. Median reach was 12% of clinicians' appointments with patients with posttraumatic stress disorder. Reach was predicted by flow of interested patients (incident response ratio [IRR] = 1.21 to 1.51), PE's perceived effectiveness (IRR = 1.04 to 1.31), working in a PTSD specialty clinic (IRR = 1.06 to 1.26), seeing more patients weekly (IRR = 1.04 to 1.25), and seeing fewer patients in groups (IRR = 0.83 to 0.99). Most clinicians trained in PE sustained use of the treatment, but on a limited basis. Strategies to increase reach of PE should address organizational barriers and patient engagement.
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.
authors.forename: Afsoon
authors.initials: A
authors.lastname: Eftekhari
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Crowley
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.
authors.forename: Brandy N
authors.initials: BN
authors.lastname: Smith
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Kuhn
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Trent
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Martin
authors.affiliation: National Center for PTSD Dissemination & Training Division, VA Palo Alto Health Care System, Menlo Park, California, USA.
authors.forename: Thuy
authors.initials: T
authors.lastname: Tran
authors.affiliation: Palo Alto University, Palo Alto, California, USA.
authors.forename: Josef I
authors.initials: JI
authors.lastname: Ruzek
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000193:education / Q000706:statistics & numerical data*; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011570:Psychiatry / Q000193:education / Q000706:statistics & numerical data; D011584:Psychology / Q000193:education / Q000706:statistics & numerical data; D012947:Social Work / Q000193:education / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D017132:Workplace