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VA practice patterns and practice guidelines for treating posttraumatic stress disorder.

Craig S Rosen1, Helen C Chow, John F Finney

  • 1National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA. crosen@stanford.edu

Journal of Traumatic Stress
|July 16, 2004
PubMed
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This study compared U.S. Department of Veterans Affairs (VA) clinicians' practices for treating posttraumatic stress disorder (PTSD) with recent guidelines. While some practices aligned, exposure therapy for PTSD was rarely used, indicating a gap in veteran care.

Area of Science:

  • Clinical Psychology
  • Psychiatry
  • Veterans Health Administration (VA) Healthcare

Background:

  • The 2000 International Society for Traumatic Stress Studies (ISTSS) guidelines offer recommendations for posttraumatic stress disorder (PTSD) treatment.
  • Understanding the alignment of current clinical practices within the Veterans Health Administration (VA) with these guidelines is crucial for optimizing veteran care.
  • Pre-guideline dissemination practices needed evaluation to establish a baseline for future implementation studies.

Purpose of the Study:

  • To compare prevailing PTSD assessment and treatment practices among clinicians in VA medical centers with the 2000 ISTSS practice guidelines.
  • To identify specific practices that were consistent or inconsistent with guideline recommendations prior to widespread dissemination.
  • To inform future research on factors influencing the implementation of evidence-based PTSD treatments in the VA system.

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Main Methods:

  • A survey was administered to clinicians across 6 VA medical centers in 1999 (n=321) and 2001 (n=271).
  • The survey assessed the utilization of various assessment and treatment procedures for PTSD.
  • Data were analyzed to determine the consistency of reported practices with ISTSS guideline recommendations.

Main Results:

  • Practices aligning with guidelines included psychoeducation, coping skills training, screening for depression and substance use, and prescribing SSRIs, anticonvulsants, and trazodone.
  • PTSD and trauma assessment, anger management, and sleep hygiene were implemented less consistently.
  • Exposure therapy, a key guideline recommendation, was rarely utilized by surveyed clinicians.

Conclusions:

  • Significant gaps exist between ISTSS PTSD treatment guidelines and actual clinical practice within the VA, particularly concerning exposure therapy.
  • Further investigation into training, resource availability, and organizational factors is necessary to facilitate the effective implementation of PTSD guidelines.
  • Enhancing the adoption of evidence-based PTSD treatments is essential for improving care for veterans.