Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial

Area of Science:

• Telemedicine and digital health interventions
• Mental health services research
• Veterans health

Background:

• Posttraumatic stress disorder (PTSD) is a prevalent and disabling condition.
• Geographic barriers limit rural veterans' access to evidence-based PTSD treatments.
• Existing treatments like psychotherapy and pharmacotherapy are effective but underutilized in rural areas.

Purpose of the Study:

• To evaluate a telemedicine-based collaborative care model for improving engagement in evidence-based PTSD treatment.
• To assess the effectiveness of the Telemedicine Outreach for PTSD (TOP) intervention.
• To determine if telemedicine can overcome geographic barriers for rural veterans seeking PTSD care.

Main Methods:

• Pragmatic randomized effectiveness trial (Telemedicine Outreach for PTSD study).
• 265 rural veterans with PTSD recruited from VA outpatient clinics.
• Intervention group received collaborative care via telemedicine; control group received usual care.

Main Results:

• 54.9% of the TOP group received cognitive processing therapy vs. 12.1% in the usual care group (OR, 18.08; P < .001).
• TOP group showed significantly greater reductions in PTSD severity scores at 6 and 12 months.
• Attendance at 8+ therapy sessions predicted symptom improvement and mediated the intervention effect.

Conclusions:

• Telemedicine-based collaborative care effectively engages rural veterans in evidence-based psychotherapy.
• The TOP intervention successfully improved PTSD outcomes by overcoming access barriers.
• This model demonstrates the potential of telemedicine to enhance mental healthcare delivery for underserved veteran populations.