290029
Randomized trial of a web-based nurse-assisted PTSD self-management intervention for primary care in combat veterans
Wednesday, November 6, 2013
: 12:30 p.m. - 12:50 p.m.
Charles Engel, MD, MPH,
Deployment Health Clinical Center/Department of Psychiatry, Walter Reed National Military Medical Center/Uniformed Services University of the Health Sciences, Bethesda, MD
Kristie Gore, PhD,
Deployment Health Clinical Center, Walter Reed National Military Medical Center, Bethesda, MD
T. Ray Coe, PhD,
Nursing Research, Carl R. Darnall Army Medical Center, Ft Hood, TX
Derik Yeager, MS,
Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC
Xian Liu, PhD,
Deployment Health Clinical Center/Department of Psychiatry, Walter Reed National Military Medical Center/Uniformed Services University of the Health Sciences, Bethesda, MD
Robert Ursano, MD,
Center for the Study of Traumatic Stress/Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
Improved access to effective primary care-based treatments for PTSD may permit early intervention among previously underserved service members, thereby improving long-term outcomes. This randomized controlled trial examined the efficacy of DESTRESS-PC, a brief, self-directed, cognitive-behavioral, web-based intervention specifically tailored to the treatment of war-related Posttraumatic Stress Disorder (PTSD), compared to Optimized Usual Primary Care PTSD Treatment (OUC). Participants were 80 veterans of recent military conflicts with PTSD seeking primary care treatment at one of three Veterans Affairs (VA) and four Army clinics. DESTRESS-PC consisted of logins to a secure website three times per week for six weeks and monitoring by a study nurse. All participants received nurse care management in the form of phone check-ins every two weeks and feedback to their primary care providers. Blinded raters assessed outcomes 6, 12, and 18 weeks post-randomization. Study hypotheses were partially supported. DESTRESS-PC was associated with a significantly greater decrease in PTSD (PCLprimary outcome) and depression (PHQ-8) symptoms compared to OUC at the 12-week assessment (PCL = 12.6±16.6 versus 5.7±12.5, p<0.05; PHQ-8 = 3.6± 4.9 versus 1.5±4.4, p<.05). VA participants (but not DoD participants) evidenced a similar pattern of results; yet, between-group effect sizes were larger, ranging from .30 to .59. Notably, there was a dose effect: the number of logins correlated significantly with PTSD outcomes. None of the other secondary outcomes (anxiety, somatic symptoms, and functional status) were significant. DESTRESS-PC offers promise as a means of delivering effective, early PTSD treatment in primary care to reduce chronicity, particularly for Veterans.
Learning Areas:
Social and behavioral sciences
Learning Objectives:
Describe DESTRESS-PC, a brief, self-directed, cognitive-behavioral, web-based intervention specifically tailored to the treatment of war-related Posttraumatic Stress Disorder.
Describe outcomes of the randomized controlled trial of DESTRESS-PC compared to Optimized Usual Primary Care PTSD Treatment.
Discuss promising avenues for reaching secondary outcomes of interest through modifications in DESTRESS-PC.
List two secondary outcomes that were non-significant.
Keyword(s): Veterans, Primary Care
Presenting author's disclosure statement:Qualified on the content I am responsible for because: As a researcher in the Deployment Health Clinical Center over the past 8 years, I have been an investigator on multiple federally-funded grants focused on the primary care treatment of postttraumatic stress disorder in military service members and have collaborated with many experts in the field. I also served as the study director of this randomized controlled trial.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
