MedicalResearch.com Interview with:
Bradley E. Belsher, Ph.D.
Chief of Research Translation and Integration,
Deployment Health Clinical Center,
Defense Center of Excellence for PH
Research Assistant Professor, Department of Psychiatry
Uniformed Services University of the Health Sciences
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: One out of five U.S. military service members returning from overseas military conflicts meets screening criteria for at least one mental health condition, yet fewer than half of service members will receive help from a mental health professional. The consequences of inadequate mental health treatment are considerable and can lead to significant social and functional problems for service members and their families. In response to these mounting concerns, the Military Health System (MHS) has increased efforts to expand and improve the identification and treatment of mental health disorders. Given that the average service member visits primary care three times each year, the MHS has invested considerable resources into the integration of mental health services into the primary care setting. Collaborative care is an effective model for integrating mental health services into primary care and has demonstrated effectiveness in treating different mental health conditions to include depression and anxiety disorders. However, no previous studies have examined whether the concept can work in the MHS.
Recently, the first large-scale, randomized effectiveness trial evaluating an integrated health care model in primary care for PTSD and depression in the DoD was conducted. This trial randomized 666 military members treated across six large Army bases to a centrally-assisted collaborative telecare (CACT) approach for PTSD and depression or to the existing standard of care (usual collaborative care). This effectiveness trial targeted a large population of service members as they came into primary care and minimized exclusion criteria to improve the generalizability of the findings and broaden the applicable reach of the intervention.
MedicalResearch.com: What are the main findings?
Response: The study revealed that the centrally-assisted collaborative telecare approach improved outcomes for service members in multiple ways. Patients randomized to CACT experienced significant improvements in PTSD and depression symptoms as compared to peers who did not receive the extra support. Twenty-five percent of military members with PTSD who were treated in the CACT model showed a 50 percent improvement in their self-reported symptoms, compared to 17 percent for those treated under the first model. Among patients with depression, 30 percent treated under the CACT model showed a 50 percent improvement in symptoms after a year, compared to 20 percent for the first model. The study also found that CACT increased the amount of care that service members received as based on utilization and self-report data. Patients treated under the model had more telephone contact with care managers and more months on appropriate medication for PTSD and depression. Patients also received significantly more mental health care services generally, with patterns of care indicating that patients were better triaged to specialty mental health care based on the severity of their symptoms.
MedicalResearch.com: What should readers take away from your report?
Response: This large effectiveness trial revealed that a centrally-assisted collaborative telecare approach improves numerous outcomes for patients being treated for PTSD and depression. This was the first study of its kind. These findings are noteworthy because existing research indicates that service members who screen positive for mental health problems do not receive sufficient treatment. An advantage of this study is that it was an effectiveness trial successfully conducted in the Army using a generalizable sample of patients and providers, suggesting that this model might be feasibly and effectively delivered within the Army healthcare system.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This study tested the effectiveness of the model as a full treatment package in the Army. To further assess the readiness of this approach and promote the translation of the full model into standard clinical care across MHS, we would want to further test the scalability of this model across all military services and evaluate how the central assistance approach can be used to improve outcomes and enhance the capabilities of modestly staffed, busy primary care clinics, especially those that are in rural/remote locations. Further, it would be imperative to involve key decision makers and stakeholders to help inform the design of the model, and to identify adoption thresholds that could further galvanize the eventual implementation and adoption of the model into standard care.
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Engel CC, Jaycox LH, Freed MC, et al. Centrally Assisted Collaborative Telecare for Posttraumatic Stress Disorder and Depression Among Military Personnel Attending Primary Care: A Randomized Clinical Trial. JAMA Intern Med. Published online June 13, 2016. doi:10.1001/jamainternmed.2016.2402.
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