Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy

John C Fortney; Suparna Rajan; Heather S Reisinger; Jane Moeckli; John P Nolan; Edwin S Wong; Peter Rise; Valentina V Petrova; George G Sayre; Jeffrey M Pyne; Anouk Grubaugh; Fatma Simsek-Duran; Kathleen M Grubbs; Leslie A Morland; Bradford Felker; Paula P Schnurr

doi:10.1016/j.genhosppsych.2022.03.009

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Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy

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Open access

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Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy

John C Fortney, Suparna Rajan, Heather S Reisinger, Jane Moeckli, John P Nolan, Edwin S Wong, Peter Rise, Valentina V Petrova, George G Sayre, Jeffrey M Pyne, …

General hospital psychiatry, Vol.77, pp.109-117

07/2022

DOI: 10.1016/j.genhosppsych.2022.03.009

PMID: 35596963

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Abstract

To address barriers to trauma-focused psychotherapy for veterans with posttraumatic stress disorder (PTSD), we compared two implementation strategies to promote the deployment of telemedicine collaborative care. We conducted a Hybrid Type III Effectiveness Implementation trial at six VA medical centers and their 12 affiliated Community Based Outpatient Clinics. The trial used a stepped wedge design and an adaptive implementation strategy that started with standard implementation, followed by enhanced implementation for VA medical centers that did not achieve the performance benchmark. Implementation outcomes for the 544 veterans sampled from the larger population targeted by the intervention were assessed from chart review (care management enrollment and receipt of trauma-focused psychotherapy) and telephone survey (perceived access and PTSD symptoms) after each implementation phase. The primary outcome was enrollment in care management. There was no significant difference between standard implementation and enhanced implementation on any of the implementation outcomes. 41.6% of sampled veterans had a care manager encounter, but only 6.0% engaged in trauma-focused psychotherapy. While telemedicine collaborative care was shown to be effective at engaging veterans in trauma-focused psychotherapy in a randomized controlled trial, neither standard nor enhanced implementation strategies were sufficient to support successful deployment into routine care. ClinicalTrials.gov Identifier: NCT02737098.

Ambulatory Care Facilities

Humans

Psychotherapy

Stress Disorders, Post-Traumatic - therapy

Telemedicine

United States

United States Department of Veterans Affairs

Veterans

Details

Title: Subtitle: Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the U.S. Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy
Creators: John C Fortney - University of Washington
Suparna Rajan - VA Puget Sound Health Care System
Heather S Reisinger - University of Iowa
Jane Moeckli - Iowa City VA Health Care System
John P Nolan - VA Puget Sound Health Care System
Edwin S Wong - University of Washington
Peter Rise - VA Puget Sound Health Care System
Valentina V Petrova - VA Puget Sound Health Care System
George G Sayre - VA Puget Sound Health Care System
Jeffrey M Pyne - University of Arkansas for Medical Sciences
Anouk Grubaugh - Medical University of South Carolina
Fatma Simsek-Duran - University of Iowa
Kathleen M Grubbs - University of Iowa
Leslie A Morland - University of Iowa
Bradford Felker - University of Washington
Paula P Schnurr - University of California San Diego
Resource Type: Journal article
Publication Details: General hospital psychiatry, Vol.77, pp.109-117
DOI: 10.1016/j.genhosppsych.2022.03.009
PMID: 35596963
NLM abbreviation: Gen Hosp Psychiatry
ISSN: 0163-8343
eISSN: 1873-7714
Grant note: DOI: 10.13039/100007181, name: VA QUERI
Language: English
Date published: 07/2022
Academic Unit: Psychiatry; Center for Social Science Innovation; Internal Medicine
Record Identifier: 9984296257702771

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