title: Usual Care for Rural Veterans With Posttraumatic Stress Disorder.
abstract: Community-Based Outpatient Clinics (CBOCs) provide primary-care-based mental health services to rural veterans who live long distances from Veterans Affairs (VA) hospitals. Characterizing the composition of usual care will highlight the need and potential strategies to improve access to and engagement in evidence-based psychotherapy for posttraumatic stress disorder (PTSD).
  
  
  
  Veterans (N = 132) with PTSD recruited from 5 large- (5,000-10,000 patients) and 6 medium-sized (1,500-4,999) CBOCs were enrolled in the usual care arm of a randomized control trial for a PTSD collaborative care study. Chart review procedures classified all mental health encounters during the 1-year study period into 10 mutually exclusive categories (7 psychotherapy and 3 medication management).
  
  
  
  Seventy-two percent of participants received at least 1 medication management encounter with 30% of encounters being delivered via interactive video. More than half of veterans (58.3%) received at least 1 session of psychotherapy. Only 12.1% received a session of therapy classified as an evidence-based psychotherapy for PTSD. The vast majority of psychotherapy encounters were delivered in group format and only a small proportion were delivered via interactive video.
  
  
  
  Findings suggest that veterans diagnosed with PTSD who receive their mental health treatment in large and medium CBOCs are likely to receive medication management, and very few veterans received evidence-based psychotherapy. There may be ways to increase access to evidence-based psychotherapy by expanding the use of interactive video to connect specialty mental health providers with patients, hosted either in CBOCs or in home-based care, and to offer more group-based therapies.
authors.affiliation: Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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.|Division of Population Health, Department of Psychiatry, University of Washington, Seattle, Washington.
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.affiliation: Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Tim
authors.initials: T
authors.lastname: Kimbrell
authors.affiliation: Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.affiliation: Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Teresa
authors.initials: T
authors.lastname: Hudson
authors.affiliation: Department of Psychiatry, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
authors.forename: Dean
authors.initials: D
authors.lastname: Robinson
authors.affiliation: Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.|South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.
authors.forename: William Mark
authors.initials: WM
authors.lastname: Moore
authors.affiliation: VA Loma Linda Health Care System, Loma Linda, California.
authors.forename: Paul
authors.initials: P
authors.lastname: Custer
authors.affiliation: Department of Psychiatry, Louisiana State University Health Sciences Center, Shreveport, Louisiana.|Overton Brooks VA Medical Center, Shreveport, Louisiana.
authors.forename: Ronald
authors.initials: R
authors.lastname: Schneider
authors.affiliation: National Center for PTSD, VA Medical Center, White River Junction, Vermont.|Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
authors.forename: Paula P
authors.initials: PP
authors.lastname: Schnurr
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D059039:Standard of Care / Q000639:trends*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D017216:Telemedicine / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*
keywords: access to care; health services research; mental health; posttraumatic stress disorder; veterans