TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - community based interventions
KW - Community Mental Health Services/organization & administration
KW - Cooperative Behavior
KW - Delivery of Health Care, Integrated/organization & administration
KW - Female
KW - Health Services Research/methods
KW - Humans
KW - Male
KW - Medicaid
KW - Medically Underserved Area
KW - Mental Health
KW - Middle Aged
KW - New Jersey
KW - New York
KW - Patient Care Team/organization & administration
KW - Patient Dropouts/statistics & numerical data
KW - Patient Selection
KW - primary care
KW - Primary Health Care/organization & administration
KW - PTSD
KW - Quality Improvement/organization & administration
KW - Quality of Life
KW - Stress Disorders, Post-Traumatic/diagnosis/therapy
KW - Young Adult
AU - L. S. Meredith
AU - D. P. Eisenman
AU - B. Han
AU - B. L. Green
AU - S. Kaltman
AU - E. C. Wong
AU - M. Sorbero
AU - C. Vaughan
AU - A. Cassells
AU - D. Zatzick
AU - C. Diaz
AU - S. Hickey
AU - J. R. Kurz
AU - J. N. Tobin
A1 - 
AB - BACKGROUND: The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7% for PCM patients and 60.6% for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14% higher (p < 0.01) and mental health medication prescription rates that were 15.2% higher (p < 0.01) than patients with no engagement. CONCLUSIONS: A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.
BT - Journal of general internal medicine
C5 - Education & Workforce
CP - 5
CY - United States
DO - 10.1007/s11606-016-3588-3
IS - 5
JF - Journal of general internal medicine
N2 - BACKGROUND: The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7% for PCM patients and 60.6% for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14% higher (p < 0.01) and mental health medication prescription rates that were 15.2% higher (p < 0.01) than patients with no engagement. CONCLUSIONS: A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.
PP - United States
PY - 2016
SN - 1525-1497; 0884-8734
SP - 509
EP - 517
EP - 
T1 - Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial
T2 - Journal of general internal medicine
TI - Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial
U1 - Education & Workforce
U2 - 26850413
U3 - 10.1007/s11606-016-3588-3
VL - 31
VO - 1525-1497; 0884-8734
Y1 - 2016
ER -