Telephone Monitoring and Support After Discharge From Residential PTSD Treatment: A Randomized Controlled Trial

Rosen, Craig S.; Tiêt, Quyên Q.; Harris, Alex H. S.; Julian, Terri; Moore, William M.; Owen, Richard R.; Rogers, Susan; Rosito, Olga; Smith, Dale E.; Smith, Mark W.; Schnurr, Paula P.

doi:10.1176/appi.ps.201200142

Cited by 35 publications

(48 citation statements)

References 52 publications

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“…This interpretation is consistent with the finding that, of the 3 previous randomized clinical trials of collaborative care for PTSD, only the intervention with an evidence-based psychotherapy component had a significant treatment effect. 25,26,28,29 Although pharmacotherapyfocused collaborative care has been shown to be effective for depression, [47][48][49] these results suggest that the larger effect size associated with collaborative care models that have pharmacotherapy and psychotherapy components 50 is needed to improve PTSD outcomes among veterans. Our findings suggest that collaborative care models can encourage veterans to initiate and adhere successfully to evidencebased psychotherapies for PTSD.…”

Section: Discussionmentioning

confidence: 99%

“…27 A trial conducted among 195 primary care patients at 4 large urban VAMCs 28 found no differences in PTSD outcomes between veterans randomized to collaborative care and UC. Another trial conducted among 355 veterans discharged from residential PTSD treatment 29 also failed to show a clinical benefit of collaborative care. In addition to the differences between civilian and veteran populations in these trials, an important distinction between the interventions tested is that only the one tested by Zatzick et al 25,26 specifically facilitated the delivery of evidence-based psychotherapy in addition to optimizing pharmacotherapy.…”

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confidence: 99%

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Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder

Fortney¹,

Pyne²,

Kimbrell³

et al. 2015

JAMA Psychiatry

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243

190

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IMPORTANCE Posttraumatic stress disorder (PTSD) is prevalent, persistent, and disabling. Although psychotherapy and pharmacotherapy have proven efficacious in randomized clinical trials, geographic barriers impede rural veterans from engaging in these evidence-based treatments.OBJECTIVE To test a telemedicine-based collaborative care model designed to improve engagement in evidence-based treatment of PTSD. DESIGN, SETTING, AND PARTICIPANTSThe Telemedicine Outreach for PTSD (TOP) study used a pragmatic randomized effectiveness trial design with intention-to-treat analyses. Outpatients were recruited from 11 Department of Veterans Affairs (VA) community-based outpatient clinics serving predominantly rural veterans. Inclusion required meeting diagnostic criteria for current PTSD according to the Clinician-Administered PTSD Scale. Exclusion criteria included receiving PTSD treatment at a VA medical center or a current diagnosis of schizophrenia, bipolar disorder, or substance dependence. Two hundred sixty-five veterans were enrolled from November 23, 2009, through September 28, 2011, randomized to usual care (UC) or the TOP intervention, and followed up for 12 months.INTERVENTIONS Off-site PTSD care teams located at VA medical centers supported on-site community-based outpatient clinic providers. Off-site PTSD care teams included telephone nurse care managers, telephone pharmacists, telepsychologists, and telepsychiatrists. Nurses conducted care management activities. Pharmacists reviewed medication histories. Psychologists delivered cognitive processing therapy via interactive video. Psychiatrists supervised the team and conducted interactive video psychiatric consultations. MAIN OUTCOMES AND MEASURESThe primary outcome was PTSD severity as measured by the Posttraumatic Diagnostic Scale. Process-of-care outcomes included medication prescribing and regimen adherence and initiation of and adherence to cognitive processing therapy. RESULTSDuring the 12-month follow-up period, 73 of the 133 patients randomized to TOP (54.9%) received cognitive processing therapy compared with 16 of 132 randomized to UC (12.1%) (odds ratio, 18.08 [95% CI, 7.96-41.06]; P < .001). Patients in the TOP arm had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 29.1) compared with those in the UC arm (from 33.5 to 32.1) at 6 months (β = −3.81; P = .002). Patients in the TOP arm also had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 30.1) compared with those in the UC arm (from 33.5 to 31.7) at 12 months (β = −2.49; P=.04). There were no significant group differences in the number of PTSD medications prescribed and adherence to medication regimens were not significant. Attendance at 8 or more sessions of cognitive processing therapy significantly predicted improvement in Posttraumatic Diagnostic Scale scores (β = −3.86 [95% CI, −7.19 to −0.54]; P = .02) and fully mediated the intervention effect at 12 months. CONCLUSIONS AND RELEVANCETelemedicine-based collaborative car...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder

Fortney¹,

Pyne²,

Kimbrell³

et al. 2015

JAMA Psychiatry

Self Cite

243

190

View full text Add to dashboard Cite

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“…Several studies show positive effects, but sometimes only in certain subgroups, typically the more severe patients who make poorer initial progress in treatment (10–12,14). However, two recent studies produced negative results (13,15). Studies support the use of IVR and PDA technology to conduct assessments, but there are few data on whether IVR- or PDA-based interventions produce better substance use outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Over a 12-month follow up, there were no differences between the two conditions on self-report measures of PTSD symptoms, alcohol use, drug use, or depression (15). The authors noted that the TAU control condition had surprisingly good outcomes, which reduced the likelihood of showing an effect.…”

Section: Telephone-based Interventionsmentioning

confidence: 99%

The Use of New Communications Technologies to Evaluate and Intervene in Substance Use Disorders

McKay

2014

Curr Behav Neurosci Rep

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The widespread availability of high speed, mobile cellular telephones and other advances in communication technology have the potential to change the way that interventions for substance use disorders (SUD) are delivered and how progress is monitored. This article reviews recent research on the use of new technology to monitor progress and deliver interventions for SUD. Several studies of telephone-based interventions show positive effects, but sometimes only in certain subgroups. However, other studies produced negative results. Studies support the use of interactive voice response (IVR) and personal digital assistants (PDAs) to conduct assessments, but there is little data on whether IVR- or PDA-based interventions improve outcomes. Text messaging has received comparatively little research, but appears promising as a means to conduct assessments and deliver automated interventions. Finally, smartphone technology provides the widest range of features and interventions and the greatest flexibility, but few intervention studies that use them have been conducted.

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“…Indeed, among telephone-monitored patients, 60%, 64%, and 54% received continuing mental health outpatient care at the 3-, 9-, and 15-month follow-ups, respectively; among usual care patients, corresponding percentages were 65%, 63%, and 59%. In this regard, Rosen et al (2013) examined whether adding a telephone care management protocol to usual continuing care improved patients’ outcomes in the year after discharge from residential mental health treatment; over one-half of study participants had co-occurring mental health and substance use disorders. They found no differences in substance use, psychiatric symptoms, time to first outpatient visit or rehospitalization, or number of outpatient visits between patients who received telephone care management and usual care at four months or one year postdischarge.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

Timko

Harris

Jannausch

et al. 2019

Drug and Alcohol Dependence

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Background: Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods: This randomized controlled trial (n=406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (3 months post-baseline) and 9 and 15 months post-baseline (73% followed). Primary outcomes were number of days, out of the past 30, of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results: Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions: Among these patients, improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.

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Telephone Monitoring and Support After Discharge From Residential PTSD Treatment: A Randomized Controlled Trial

Cited by 35 publications

References 52 publications

Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder

Telemedicine-Based Collaborative Care for Posttraumatic Stress Disorder

The Use of New Communications Technologies to Evaluate and Intervene in Substance Use Disorders

Randomized controlled trial of telephone monitoring with psychiatry inpatients with co-occurring substance use and mental health disorders

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