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Randomized Controlled Trial
. 2023 Jul;38(Suppl 3):905-912.
doi: 10.1007/s11606-023-08130-6. Epub 2023 Mar 17.

A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients

Kyle Possemato  1 , Emily Johnson  2 , Kimberly Barrie  2 , Sharfun Ghaus  3 , Delilah Noronha  3 , Michael Wade  2 , Mark A Greenbaum  3   4 , Craig Rosen  3   5 , Marylene Cloitre  3   5 , Jason Owen  3 , Shaili Jain  3   5 , Gregory Beehler  2 , Annabel Prins  3 , Karen Seal  6   7 , Eric Kuhn  3   5
Affiliations
Randomized Controlled Trial

A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients

Kyle Possemato et al. J Gen Intern Med. 2023 Jul.

Abstract

Background: Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed.

Objective: To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care.

Design: Multi-site randomized pragmatic clinical trial.

Participants: A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment.

Intervention: CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the "PTSD Coach" mobile app. Four 30-min sessions encourage daily use of symptom management strategies.

Main measures: PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8 weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records.

Key results: Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D = .28, p = .021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p < .001).

Conclusions: A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.

Keywords: PTSD; Veterans; mHealth; mental health; primary care.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Recruitment and retention flow diagram.
See this image and copyright information in PMC

References

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