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

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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.

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References

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Book  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

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Correspondence to Joan M. Cook.

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Conflict of interest

Joan M. Cook, John E. Zeber, Vanessa Simiola, Rebecca Rossom, Jeffrey F. Scherrer, Ashli A. Owen-Smith, Brian K. Ahmedani, Kiumars Zolfaghari, and Laurel A. Copeland declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

Study procedures were approved or exempted from review by each healthcare system’s Institutional Review Board. Where applicable, a waiver of informed consent was obtained.

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Cook, J.M., Zeber, J.E., Simiola, V. et al. Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems. J Clin Psychol Med Settings 28, 221–228 (2021). https://doi.org/10.1007/s10880-020-09706-8

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  • DOI: https://doi.org/10.1007/s10880-020-09706-8

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