Telemedicine Expands to Provide Care for Rural Veterans With PTSD

Many Have No Access to Psychotherapy Otherwise

By Annette M. Boyle

SEATTLE – For rural veterans, the distance to a VAMC often creates a major barrier to care, particularly for treatments that require multiple trips. Telemedicine might break down those barriers, offering expanded treatment options for veterans and more hope to those suffering from post-traumatic stress disorder (PTSD).

VA social worker Amy Mitchell, shown here with James Love, helps conduct outreach as part of the Alabama  Veterans Rural Health Initiative. VA photo by Joe DeSciose

VA social worker Amy Mitchell, shown here with James Love, helps conduct outreach as part of the Alabama
Veterans Rural Health Initiative. VA photo by Joe DeSciose

More than 502,000 veterans receiving care through the VA have a diagnosis of PTSD, yet relatively few rural veterans are treated for the condition.

John Fortney

John Fortney, PhD

“Barriers to care such as travel distance and stigma often prevent many veterans from initiating psychotherapy or contribute to the high dropout rate” for these treatments, which require multiple sessions, said John Fortney, PhD, research health science specialist at the VA Puget Sound Health Care System and associate director for research at the AIMS Center at the University of Washington in Seattle.

Fortney and his colleagues studied a telemedicine-based collaborative care model for PTSD compared to usual care in 265 veterans being treated at 11 community-based outpatient clinics from Nov. 23, 2009, to Sept. 28, 2011. Nearly all the patients in both groups previously had been treated for PTSD using psychotropic medications, counseling or both. The patients had severe PTSD, with mean Clinician-Administered PTSD Scale scores of 75, and significant comorbidities. Nearly 80% had a diagnosis of major depressive disorder, 44% had panic disorder, and 67% experienced generalized anxiety disorder.

In results published recently in JAMA Psychiatry, the researchers found that more patients in the telemedicine group received cognitive processing therapy and had significantly larger drops in Post-Traumatic Diagnostic Scale scores after six and 12 months. 1

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