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Articles   |    
Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in VA Specialty Clinics
Bradley V. Watts, M.D., M.P.H.; Brian Shiner, M.D., M.P.H.; Lisa Zubkoff, Ph.D.; Elizabeth Carpenter-Song, Ph.D.; Julia M. Ronconi, M.S., A.P.R.N.; Craig M. Coldwell, M.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300176
View Author and Article Information

Dr. Watts, Dr. Shiner, and Dr. Zubkoff are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and with the Veterans Affairs (VA) National Center for Patient Safety Field Office, White River Junction, Vermont (e-mail: bradley.v.watts@dartmouth.edu). Dr. Carpenter-Song is with the Dartmouth Psychiatric Research Center, Lebanon, New Hampshire. Ms. Ronconi is with the Research Service, White River Junction VA Medical Center, White River Junction. Dr. Coldwell is with the Mental Health Service, VA New England Healthcare System, Bedford, Massachusetts, and with the Department of Psychiatry, Boston University School of Medicine, Boston.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The U.S. Department of Veterans Affairs (VA) has engaged in substantial efforts to promote the use of evidence-based psychotherapies for posttraumatic stress disorder (PTSD). The authors evaluated the effectiveness of these efforts.

Methods  This study used a cross-sectional, mixed-methods evaluation of treatment provided by the VA at specialty PTSD clinics in New England during the first six months of fiscal year 2010. Natural language processing algorithms were applied to clinical notes to determine utilization of evidence-based psychotherapy (prolonged exposure therapy and cognitive-processing therapy) among patients who were newly diagnosed as having PTSD. Data regarding efforts to implement evidence-based psychotherapy and other clinic characteristics were obtained through qualitative interviews with clinical and administrative staff (N=30), and the Promoting Action on Research Implementation in Health Services framework was used to identify clinic factors associated with use of evidence-based psychotherapy.

Results  Six percent of patients (N=1,924) received any sessions of an evidence-based psychotherapy for PTSD (median=five sessions). Several clinic factors were associated with an increased rate of implementation, including prior experience with use of the treatments, customization of training, and prolonged contact with the implementation and training team. Facilitation with broad training goals and clinics with highly organized systems of care were negatively associated with implementation.

Conclusions  Few patients with PTSD received evidence-based psychotherapy for PTSD during their first six months of treatment at a VA specialty PTSD clinic. The implementation framework poorly predicted factors associated with uptake of evidence-based psychotherapy. These results suggest that additional research is needed to understand implementation of evidence-based therapy in mental health settings.

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Table 1Overarching questions for evaluating implementation of evidence-based psychotherapy, by element of the PARiHS frameworka
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a PARiHS, Promoting Action on Research Implementation in Health Services

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Table 2Receipt of evidence-based psychotherapy among patients of PTSD specialty clinics during the first six months of clinic enrollment
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a Prolonged exposure

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b Cognitive-processing therapy

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Table 3Correlation between element of the PARiHS framework and receipt of evidence-based psychotherapy for PTSDa
Table Footer Note

a PARiHS, Promoting Action on Research Implementation in Health Services

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