Top

Journal of Clinical Psychology in Medical Settings

Published in:

01-06-2021 | Psychotherapy

Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems

Authors: Joan M. Cook, John E. Zeber, Vanessa Simiola, Rebecca Rossom, Jeffrey F. Scherrer, Ashli A. Owen-Smith, Brian K. Ahmedani, Kiumars Zolfaghari, Laurel A. Copeland

Published in: Journal of Clinical Psychology in Medical Settings | Issue 2/2021

Abstract

Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC). The purpose of this study was to compare the clinical characteristics and health care utilization of PTSD patients diagnosed in PC versus in specialty mental health care (MHC) across five large, civilian, not-for-profit healthcare systems. Electronic claims and medical record data on patients treated during 2014 were analyzed. Treatment was considered in terms of initiation and dose (i.e., psychotherapy sessions; pharmacotherapy—prescription psychotropics). Of 5256 patients aged 15–88 with a diagnosis of PTSD, 84.4% were diagnosed by a MHC provider. Patients diagnosed by MHC providers had 4 times the rate of and more enduring psychotherapy than those diagnosed by PC providers. Receipt of psychotropics varied by provider type, with generally higher prescription fill levels for patients in MHC. Strategies to better align patient needs with access and treatment modality in PC settings are needed.

Chung, J. Y., Frank, L., Subramanian, A., Galen, S., Leonhard, S., & Green, B. L. (2012). A qualitative evaluation of barriers to care for trauma-related mental health problems among low-income minorities in primary care. Journal of Nervous and Mental Disease, 200, 438–443. https://doi.org/10.1097/NMD.0b013e31825322b3.CrossRef

Cook, J. M., Dinnen, S., Thompson, R., Simiola, V., & Schnurr, P. P. (2014). Changes in implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: A national investigation. Journal of Traumatic Stress, 27, 137–143. https://doi.org/10.1002/jts.21902.CrossRefPubMedPubMedCentral

Department of Veterans Affairs & Department of Defense (2017). VA/DoD Clinical Practice Guideline for the management of posttraumatic stress and acute stress disorder (version 3.0). Washington, DC: Authors. Retrieved March 27, 2019, from https://www.healthquality.va.gov/guidelines/mh/ptsd/index.asp

DeViva, J. C. (2014). Treatment utilization among OEF/OIF veterans referred for psychotherapy for PTSD. Psychological Services, 11, 179–184.CrossRef

Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. New York: Oxford.CrossRef

Green, B. L., Kaltman, S., Frank, L., Glennie, M., Subramanian, A., Fritts-Wilson, M., …, Chung, J. (2011). Primary care providers’ experiences with trauma patients: A qualitative study. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 37–41.

Greene, T., Neria, Y., & Gross, R. (2016). Prevalence, detection and correlates of PTSD in the primary care setting: A systematic review. Journal of Clinical Psychology in Medical Settings, 23, 160–180. https://doi.org/10.1007/s10880-016-9449-8.CrossRefPubMed

Harpaz-Rotem, I., Rosenheck, R. A., Mohamed, S., & Desai, R. A. (2008). Pharmacologic treatment of posttraumatic stress disorder among privately insured Americans. Psychiatric Services, 59, 1184–1190. https://doi.org/10.1176/appi.ps.59.10.1184.CrossRefPubMed

HCSRN. Mental Health Research Network, 2017. Retrieved March 27, 2019, from https://hcsrn.org/mhrn/en/.

HMSA Provider Resource Center. (2017). CPT codes for psychiatric and psychological procedure. Retrieved March 27, 2019, from https://hmsa.com/portal/provider/zav_pel.bh.CPT.500.htm.

Institute of Medicine (U.S.) Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder, & National Academies Press. (2014). Treatment for posttraumatic stress disorder in military and veteran populations: Final assessment. Washington, DC: National Academies Press.

Karlin, B. E., & Cross, G. (2014). From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs Health Care System. American Psychologist, 69, 19–33. https://doi.org/10.1037/a0033888.CrossRef

Kartha, A., Brower, V., Saitz, R., Samet, J. H., Keane, T. M., & Liebschutz, J. (2008). The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients. Medical Care, 46, 388–393. https://doi.org/10.1097/MLR.0b013e31815dc5d2.CrossRefPubMedPubMedCentral

Klassen, B. J., Porcerelli, J. H., & Markova, T. (2013). The effects of PTSD symptoms on health care resource utilization in a low-income, urban primary care setting. Journal of Traumatic Stress, 26, 636–639.CrossRef

Liebschutz, J., Saitz, R., Brower, V., Keane, T. M., Lloyd-Travaglini, C., Averbuch, T., et al. (2007). PTSD in urban primary care: High prevalence and low physician recognition. General Hospital Psychiatry, 22, 719–726. https://doi.org/10.1007/s11606-007-0161-0.CrossRef

Magruder, K. M., McLaughlin, K. A., & Elmore Borbon, D. L. (2017). Trauma is a public health issue. European Journal of Psychotraumatology, 8, 1375338. https://doi.org/10.1080/20008198.2017.1375338.CrossRefPubMedPubMedCentral

Nobles, C. J., Valentine, S. E., Zepeda, E. D., Ahles, E. M., Shtasel, D. L., & Marques, L. (2017). Usual course of treatment and predictors of treatment utilization for patients with posttraumatic stress disorder. Journal of Clinical Psychiatry, 78, e559. https://doi.org/10.4088/JCP.16m10904.CrossRef

Possemato, K., Johnson, E. M., Wray, L. O., Webster, B., & Stecker, T. (2018). The implementation and testing of a referral management system to address barriers to treatment seeking among primary care veterans with PTSD. Psychological Services, 15, 457. https://doi.org/10.1037/ser0000150.CrossRefPubMed

Regier, D. A., Goldberg, I. D., & Taube, C. A. (1978). The de facto US mental health services system: A public health perspective. Archives of General Psychiatry, 35, 685–693.CrossRef

Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings, 25, 109–126. https://doi.org/10.1007/s10880-017-9531-x.CrossRefPubMed

Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive processing therapy for PTSD: A comprehensive manual. New York: Guilford Press.

Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine, 41, 71–83. https://doi.org/10.1017/S0033291710000401.CrossRefPubMed

Ross, T. R., Ng, D., Brown, J. S., Pardee, R., Hornbrook, M. C., Hart, G., et al. (2014). The HMO Research Network Virtual Data Warehouse: A public data model to support collaboration. Egems, 2, 1049. https://doi.org/10.13063/2327-9214.1049.CrossRefPubMedPubMedCentral

Sonis, J. (2013). PTSD in primary care: An update on evidence-based management. Current Psychiatry Reports, 15, 373–384. https://doi.org/10.1007/s11920-013-0373-4.CrossRefPubMed

Spoont, M. R., Murdoch, M., Hodges, J., & Nugent, S. (2010). Treatment receipt by veterans after a PTSD diagnosis in PTSD, mental health, or general medical clinics. Psychiatric Services, 61, 58–63. https://doi.org/10.1176/appi.ps.61.1.5810.1176/ps.2010.61.1.58.CrossRefPubMed

Spottswood, M., Davydow, D. S., & Huang, H. (2017). The prevalence of posttraumatic stress disorder in primary care: A systematic review. Harvard Review of Psychiatry, 25, 159–169. https://doi.org/10.1097/HRP.0000000000000136.CrossRefPubMedPubMedCentral

Substance Abuse and Mental Health Services Administration (2014). Leading change 2.0: Advancing the behavioral health of the nation 2015–2018. Rockville, MD: Authors.

Taubman-Ben-Ari, O., Rabinowitz, J., Feldman, D., & Vaturi, R. (2001). Post-traumatic stress disorder in primary-care settings: Prevalence and physicians’ detection. Psychological Medicine, 31, 555–560. https://doi.org/10.1017/S0033291701003658.CrossRefPubMed

Walker, E. A., Katon, W., Russo, J., Ciechanowski, P., Newman, E., & Wagner, A. W. (2003). Health care costs associated with posttraumatic stress disorder symptoms in women. Archives of General Psychiatry, 60(4), 369–374.CrossRef

Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640. https://doi.org/10.1001/archpsyc.62.6.629.CrossRefPubMed

Zeiss, A. M., & Karlin, B. E. (2008). Integrating mental health and primary care services in the Department of Veterans health care system. Journal of Clinical Psychology in Medical Setting, 15, 73–78. https://doi.org/10.1007/s10880-008-9100-4.CrossRef

Title: Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems
Authors: Joan M. Cook
John E. Zeber
Vanessa Simiola
Rebecca Rossom
Jeffrey F. Scherrer
Ashli A. Owen-Smith
Brian K. Ahmedani
Kiumars Zolfaghari
Laurel A. Copeland
Publication date: 01-06-2021
Publisher: Springer US
Keywords: Psychotherapy
Care
Published in: Journal of Clinical Psychology in Medical Settings / Issue 2/2021
Print ISSN: 1068-9583
Electronic ISSN: 1573-3572
DOI: https://doi.org/10.1007/s10880-020-09706-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2021

The Role of Metacognitions on the Relationship Between Adult Attachment and Mood Symptoms in Individuals with Obesity

Exploring Post-traumatic Growth in Parkinson's Disease: A Mixed Method Study

A Systematic Review and Meta-analysis of the Distress Thermometer for Screening Distress in Asian Patients with Cancer

Death Attitudes, Palliative Care Self-efficacy, and Attitudes Toward Care of the Dying Among Hospice Nurses

Psychologists’ Leadership Roles and Leadership Training Needs in Academic Health Centers

Correlates of Post-traumatic Growth Following a Myocardial Infarction: A Systematic Review