Study: Telemedicine Could Reduce PTSD Severity for Rural Veterans

November 25, 2014 in News

Veterans with severe post-traumatic stress disorder who live in rural areas could benefit from telemedicine, according to a study published in the journal JAMA Psychiatry, Medscape reports.

Background

In 2012, more than 500,000 veterans — representing about 9% of the population covered by the Veterans Health Administration — were diagnosed with PTSD, according to the researchers.

The researchers also noted that:

  • About 37% of veterans enrolled in VHA reside in rural areas; and
  • About 66% are closer to a VHA community-based outpatient clinic than they are to a Department of Veterans Affairs medical center.

Such geographic barriers often hamper veterans who reside in rural areas from accessing the available evidence-based treatments for PTSD, according to the researchers. Specifically, they noted that it is not “typically feasible” for outpatient clinics to hire on-site psychologists or psychiatrists who have expertise in PTSD.

Details of Study

For the study, researchers randomly assigned 265 veterans with severe PTSD symptoms — most of whom lived in rural areas — to receive either telemedicine outreach for PTSD or standard care from 11 outpatient clinics (Cassels, Medscape, 11/19). About half of the veterans received each type of care (Doyle, Reuters, 11/24).

With the PTSD telehealth treatment, an offsite care team supported providers at the clinics using several telemedicine tools and sharing electronic health records. The offsite care team included:

  • Nurses who carried out care management via telephone;
  • Pharmacists available via telephone, who reviewed veterans’ medication histories;
  • Psychologists, who delivered cognitive processing therapy via video chat; and
  • Psychiatrists who supervised the offsite care team and conducted interactive consultations via video chat.

The study measured PTSD severity pre- and post-intervention, as well as measuring severity of depression and quality of life related to health.

Findings

The study found that after 12 months, among veterans receiving the PTSD telehealth intervention:

  • 54.9% received cognitive processing therapy, compared with 12.1% of those receiving standard care; and
  • 27.1% attended eight or more cognitive processing therapy sessions, compared with 5.3% of those receiving standard care.

Researchers also found that veterans receiving the telehealth intervention experienced a greater decrease in the severity of their PTSD symptoms and depression, compared with veterans who received standard care.

Further, they found that attending eight or more cognitive processing therapy sessions was correlated with improvements in the severity of veterans’ PTSD symptoms.

Implications

The researchers wrote that the study “introduce[d] a promising model for managing PTSD in a treatment-resistant population.”

In addition, they wrote that the “[f]indings suggest that telemedicine-based collaborative care can successfully engage this population in evidence-based psychotherapy for PTSD, thereby improving clinical outcomes” (Medscape, 11/19).

Lead author John Fortney added that more research is needed to develop strategies to further the widespread adoption of telehealth services for PTSD treatment in VA’s health system (Reuters, 11/24).

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