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RESPECT-PTSD: Re-Engineering Systems for the Primary Care Treatment of PTSD, A Randomized Controlled Trial

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ABSTRACT

BACKGROUND

Although collaborative care is effective for treating depression and other mental disorders in primary care, there have been no randomized trials of collaborative care specifically for patients with Posttraumatic stress disorder (PTSD).

OBJECTIVE

To compare a collaborative approach, the Three Component Model (3CM), with usual care for treating PTSD in primary care.

DESIGN

The study was a two-arm, parallel randomized clinical trial. PTSD patients were recruited from five primary care clinics at four Veterans Affairs healthcare facilities and randomized to receive usual care or usual care plus 3CM. Blinded assessors collected data at baseline and 3-month and 6-month follow-up.

PARTICIPANTS

Participants were 195 Veterans. Their average age was 45 years, 91% were male, 58% were white, 40% served in Iraq or Afghanistan, and 42% served in Vietnam.

INTERVENTION

All participants received usual care. Participants assigned to 3CM also received telephone care management. Care managers received supervision from a psychiatrist.

MAIN MEASURES

PTSD symptom severity was the primary outcome. Depression, functioning, perceived quality of care, utilization, and costs were secondary outcomes.

KEY RESULTS

There were no differences between 3CM and usual care in symptoms or functioning. Participants assigned to 3CM were more likely to have a mental health visit, fill an antidepressant prescription, and have adequate antidepressant refills. 3CM participants also had more mental health visits and higher outpatient pharmacy costs.

CONCLUSIONS

Results suggest the need for careful examination of the way that collaborative care models are implemented for treating PTSD, and for additional supports to encourage primary care providers to manage PTSD.

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Acknowledgments

This study was funded by the VA Health Services Research and Development Service. However, the views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or any US government agency.

We wish to thank the Site Principal Investigators Dzung V. Le, DO, Praveen Mehta, MD, Guna Raj, MD, Immanuel Thamban, MD, and Edwin Woo, MD and research staff (David S. Greenawalt, PhD, Kathy McNair, RN, Lisa D. Jones, Reed J. Robinson, PhD, Jack Y. Tsan, PhD, and Elizabeth S. Wiley, PhD). We also wish to thank Shelia Barry, Allison Brandt, MBA, Shuo Chen, PhD, Suzy B. Gulliver, PhD, Kathryn Kotrla, MD, Carol S. North, MD, Jeffrey Smith, PhD, John Williams, MD, Keith A. Young, PhD, and Yinong Young-Xu, DSc, for valuable assistance in planning or in implementing the study, and Charles C. Engel, MD for helpful discussions about the study findings.

Conflict of Interest

Dr. Schnurr has provided consultation and content development on PTSD for Medscape. Oxman & Dietrich are partners in 3CM, LLC, a consultant group based on their work for the MacArthur Foundation in order to disseminate their work on integrating mental health in primary care. They primarily work with the U.S. Army, but have also worked with Aetna, the University of Miami and the New York City Dept. of Health and Mental Hygiene. Dr. Smith is employed by Thomson Reuters. All other authors have no conflicts to declare.

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Authors and Affiliations

  1. National Center for PTSD, VAMC, White River Junction, VT, 05009, USA

    Paula P. Schnurr PhD, Matthew J. Friedman MD, PhD, Brian Shiner MD, MPH, Elizabeth Forshay MSW & Veronica Thurston MBA

  2. Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Paula P. Schnurr PhD, Matthew J. Friedman MD, PhD, Thomas E. Oxman MD, Allen J. Dietrich MD, Brian Shiner MD, MPH & Jiang Gui PhD

  3. 3CM, LLC, Hanover, NH, USA

    Thomas E. Oxman MD & Allen J. Dietrich MD

  4. Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Mark W. Smith PhD

  5. Thomson Reuters, Washington, DC, USA

    Mark W. Smith PhD

  6. Center for Primary Care and Outcomes Research, Stanford Medical School, Stanford, CA, USA

    Mark W. Smith PhD

Authors
  1. Paula P. Schnurr PhD
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  2. Matthew J. Friedman MD, PhD
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  4. Allen J. Dietrich MD
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  7. Elizabeth Forshay MSW
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  9. Veronica Thurston MBA
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Corresponding author

Correspondence to Paula P. Schnurr PhD.

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Trial Registration

Clinicaltrials.gov Identifier NCT00373698

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Schnurr, P.P., Friedman, M.J., Oxman, T.E. et al. RESPECT-PTSD: Re-Engineering Systems for the Primary Care Treatment of PTSD, A Randomized Controlled Trial. J GEN INTERN MED 28, 32–40 (2013). https://doi.org/10.1007/s11606-012-2166-6

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  • DOI: https://doi.org/10.1007/s11606-012-2166-6

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