Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jun;40(3):411-418.
doi: 10.1111/jrh.12790. Epub 2023 Aug 19.

Implementation strategies to improve posttraumatic stress disorder care in rural veterans

Nancy C Bernardy  1   2   3 , Lisa-Ann J Cuccurullo  2 , Macgregor Montano  2 , Michelle Bowen  4 , Kristen Breen  2 , Rebecca Matteo  2 , Bernard Cole  5
Affiliations

Implementation strategies to improve posttraumatic stress disorder care in rural veterans

Nancy C Bernardy et al. J Rural Health. 2024 Jun.

Abstract

Purpose: Prior research has noted treatment inequalities in the care of rural veterans with posttraumatic stress disorder (PTSD). This project sought to increase the delivery, or reach, of recommended PTSD treatments in 2 rural health care systems of the Department of Veterans Affairs (VA) using implementation facilitation.

Methods: The quality improvement project involved 6 months of facilitation to 2 low-reach PTSD clinics within 2 VA health care systems. The clinics were matched to a control clinic at another regional system similar in reach, rurality, and patient volume. We compared the delivery of evidence-based psychotherapies (EBPs) for PTSD at 3 timepoints: baseline, 6 months, and 1 year using difference-in-difference effect estimation. Facilitators and barriers of EBP reach were identified through interviews with clinic staff and informed specific implementation plans. We also measured reductions in benzodiazepine prescriptions and polypharmacy to determine the impact of an academic detailing intervention aimed at improving PTSD prescribing practices at the 2 sites.

Findings: EBP reach at 6 months more than doubled in the 2 PTSD clinics that received facilitation, while our control clinic experienced a decrease in EBP reach (DID = 24.6; SE = 6.71%). Both intervention clinics identified similar administrative barriers to the delivery of EBPs, offering useful information for improvement at other rural clinics. The use of academic detailing as part of our facilitation intervention further appears to have positively impacted care.

Conclusions: In this preliminary work, facilitation is a promising strategy for increasing the delivery of PTSD EBPs to veterans seen in under-resourced rural VA clinics.

Keywords: health disparities; mental health; psychology.

PubMed Disclaimer

References

REFERENCES

    1. Veterans Health Administration (VHA) Office of Rural Health. Rural Veterans. Accessed April 30, 2017. https://www.ruralhealth.va.gov/aboutus/ruralvets.asp
    1. Lund BC, Bernardy NC. Rural differences in psychiatric medication prescribing in veterans with posttraumatic stress disorder. J Rural Health. 2022;38(4):764‐772.
    1. Weeks WB, Wallace AE, Wang S, Lee A, Kazis LE. Rural‐urban disparities in health‐related quality of life within disease categories of veterans. J Rural Health. 2006;22(3):204‐211.
    1. Bumgarner DJ, Herman KG, Lewis CP, et al. Mental healthcare for rural veterans: a systematic literature review, descriptive analysis, and future directions. J Rural Ment Health. 2017;41(3):222‐233.
    1. Holder KA. Veterans in Rural America. U.S. Census Bureau: 2011‐2015.

Publication types

MeSH terms

LinkOut - more resources