Health service utilization before and after evidence-based treatment for PTSD.

Abstract

Posttraumatic stress disorder (PTSD) is associated with functional impairment, co-occurring diagnoses, and increased health care utilization. Associated high demand for health care services is an important contributor to the large public-health cost of PTSD. Treatments incorporating exposure therapy are efficacious in ameliorating or eliminating PTSD symptoms. Accordingly, the Veterans Health Administration has made significant investments toward nationwide dissemination of a manualized exposure therapy protocol, prolonged exposure (PE). PE is effective with veterans; however, the relationship between PE and mental health service utilization is unknown. The current study investigates PE as it relates to actual tracked mental health service utilization in an urban VA medical center. A sample of 60 veterans with a diagnosis of PTSD was used to examine mental health service utilization in the 12-months prior to and 12-months after being offered PE. Hierarchical Linear Models and traditional repeated-measures ANOVA were used to estimate R²- and d-type effect sizes for service utilization. Associated estimated cost saving are reported. PE was associated with large reductions in symptoms and diagnosis remission. Treatment was also associated with statistically significant, large reductions in mental health service utilization for veterans who completed treatment. Findings suggest that expanding access to PE can increase access to mental health services in general by decreasing ongoing demand for specialty care clinical services.

Mental Health Treatment for Older Veterans Newly Diagnosed with PTSD: A National Investigation

“…23,25,26 Treatment, specifically evidence-based treatments for PTSD, can reduce the suffering and interference related to trauma symptoms 39 and also decrease mental health service utilization following completion of treatment. 40 The present study has a number of limitations that should be noted. The sample was a predominantly male and Caucasian sample of veterans, which limits generalizability to civilian populations as well as to female veterans.…”

PTSD and Substance Use Disorder Among Veterans: Characteristics, Service Utilization and Pharmacotherapy

“…A single-site study of veterans in Charleston, South Carolina, demonstrated that evidence-based treatment for PTSD was associated with large reductions in symptoms and that diagnostic remission was associated with substantial reductions in mental health service utilization and health care costs, particularly for veterans who completed treatment (Tuerk et al, 2013). Similarly, researchers at the Minneapolis VA noted a decrease in individual and group therapy after veterans had received treatment for PTSD, amounting to a 39.4% decrease in cost associated with mental health care (Meyers et al, 2013).…”

Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex," "Bruno," and "Charles"

“…Based on these findings, the authors recommended that Veterans should be empowered to seek evidence-based treatments and the Department of Defense and Veterans Affairs Healthcare System should attempt to increase their capacity to deliver these treatments. Tuerk et al (2013) examined health-service utilization among Veterans who received Prolonged Exposure within a VA PTSD specialty clinic and found that, contrary to their hypotheses, Veterans who dropped out of PE continued to use mental health services at a significantly higher rate than those Veterans who completed PE. This finding underscores the economic cost of Veterans not receiving EBPs for PTSD, as the authors estimated the clinic saved $11,644 due to offering PE to the Veterans enrolled in the study.…”

“…Thus, the people who opted to receive supportive counseling or psychoeducation over a trauma-focused treatment were significantly less likely to achieve PTSD symptom remission. Although a VA PTSD Clinical Team (PCT) may want to provide ongoing support/coping for EBP nonresponders or dropouts, the clinic and Veterans will likely benefit from allocating most staff resources to providing EBPs like Prolonged Exposure because they will increase capacity which will result in more Veterans being treated (Tuerk et al, 2013). It would seem that the more clients seen would offer more opportunities to provide patient-centered care.…”