“Earlier studies have shown that PTSD treatments offered through interactive video are just as effective as therapy given in person,” said lead author John Fortney of the VA Puget Sound Health Care System in Seattle, Washington.
“We were worried about those patients living in rural areas and getting care from a community-based outpatient clinic that just don’t have psychiatrists on site,” said Fortney. “About 40 percent of veterans live in rural areas. Those are the kinds of communities that send their sons and daughters off to war.”
The research involved 265 middle-aged vets with severe PTSD symptoms who lived near an outpatient clinic that didn’t have a psychiatrist or psychologist on site from 2009 through 2011. Patients were living in Shreveport, Louisiana, Little Rock, Arkansas, and Loma Linda, California.
In addition to having severe PTSD symptoms, many of the veterans had other mental health problems as well, with 78.9 precent meeting diagnostic criteria for major depressive disorder, 44.2 percent for panic disorder, and 67.2 percent for generalized anxiety disorder.
Half of the veterans received the outpatient clinic’s regular care, and the other half were connected to an additional care team at a larger medical center via telemedicine, including nursing care managers and pharmacists calling their homes and psychiatrists providing consultations by video-chat at the outpatient clinic.
The psychiatrists then gave feedback and treatment recommendations to providers at the clinic through electronic medical records.
During the video chat, over half of the vets received cognitive processing therapy, a specific behavioral therapy developed to treat PTSD, compared to only 12 percent of the comparison group.
There were no differences in medicine prescribed between the two groups; however, patients in the telemedicine group had bigger decreases in Posttraumatic Diagnostic Scale scores at the six and 12-month mark.
“Many components of the telemedicine-based collaborative care model are currently available in the VA, including care manager programs, telepsychiatry, and in person Cognitive Processing Therapy,” Fortney said.
“However, it is not common to see the delivery of Cognitive Processing Therapy combined with the other components of the telemedicine-based collaborative care model.
“Not all patients are comfortable with interactive video technology, but the vast majority of patients are highly satisfied receiving psychiatric and psychological services via interactive video,” Fortney said.
“More research would help identify the proper strategies needed to promote the widespread adoption of this particular model of care,” he said.