title: Increased utilization of prolonged exposure and cognitive processing therapy over time: A case example from a large Veterans Affairs posttraumatic stress disorder clinic.
abstract: Prior single-site and regional studies have documented difficulties in implementing prolonged exposure (PE) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) into practice in Veterans Affairs (VA) Medical Centers, estimating that between 6% and 13% of VA patients with PTSD receive PE or CPT (Lu, Plagge, Marsiglio, & Dobscha, 2016; Mott et al., 2014; Shiner et al., 2013). However, these studies examined data from fiscal years 2008-2012, and therefore may not reflect more recent utilization patterns. Beginning in 2007, the VA invested heavily in increasing implementation of PE and CPT, including nationwide training rollouts and consultation. Given the length of time required for successful implementation of new practices, it is important to evaluate use of PE and CPT over time. We examined current use of PE and CPT at 1 VA medical center PTSD specialty clinic and compared this to prior rates for the same clinic. Chart reviews for all patients receiving a PTSD clinic initial evaluation between January 1, 2015, and May 31, 2015, indicated that 52% of patients began a course of PE or CPT within the 1-year follow-up period, representing a 5-fold increase from 2008 to 2012. We discuss changes in clinic structure, processes, training, and clinician support that might account for the successful implementation of PE and CPT in this clinic. We also present data on alternative referrals provided to patients not engaging in PE and CPT, and predictors of engagement in PE and CPT. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
authors.affiliation: Veterans Affairs (VA) Health Sciences Research and Development (HSR&D) Houston Center of Excellence, Michael E. De- Bakey VA Medical Center (VAMC).
authors.forename: Natalie E
authors.identifier: 0000-0003-4201-4956
authors.initials: NE
authors.lastname: Hundt
authors.affiliation: National Center for Posttraumatic Stress Disorder.
authors.forename: Juliette M
authors.identifier: 0000-0002-7303-3132
authors.initials: JM
authors.lastname: Harik
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Thompson
authors.affiliation: VA HSR&D Houston Center of Excellence, Michael E. DeBakey VAMC.
authors.forename: Terri L
authors.identifier: 0000-0003-0854-4216
authors.initials: TL
authors.lastname: Barrera
authors.affiliation: HSR&D Center of Innovation on Disability and Rehabilitation Research at the James A. Haley Veterans Hospital.
authors.forename: Shannon Reynolds
authors.initials: SR
authors.lastname: Miles
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000706:statistics & numerical data*; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*