New Findings on Telecare for PTSD and Depression

Peter M. Yellowlees, MBBS, MD


December 01, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

It is often difficult for members of the US military to access high-quality care for post-traumatic stress disorder (PTSD) and depression. Now a team of investigators from the RAND Corporation in Massachusetts has undertaken a study to determine the effectiveness of a centrally assisted collaborative telecare (CACT) intervention for PTSD and depression in military primary care.[1] Six hundred and sixty-six patients, 81% male and with a mean age of 31.1 years, were enrolled from 18 primary care clinics at six military installations from February 2012 to August 2013, with 12-month follow-up completed in October 2014. Randomization was to CACT (n = 332) or usual integrated care (n = 334). The CACT patients received 12 months of stepped psychosocial and pharmacologic treatment with nurse telecare management of caseloads, symptoms, and treatment. The investigators reported that both groups improved significantly on a wide range of measures and clinical outcomes for both PTSD and depression, and that overall, the CACT intervention group had modestly better outcomes than the usual integrated care group.

What does this study show us? First, and most important, it demonstrates, like many other studies, the effectiveness of integrated team-based behavioral care delivered in primary care for patients with PTSD and depression. Second, it provides support for the potential importance of technology-mediated stepped central interventions to manage populations of patients when added to usual integrated care. Given that most patients with PTSD and depression are treated in primary care, it is vital that research projects such as this one be increased to provide us with the best evidence we need to treat our patients in integrated systems of care.

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