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- Title
Implementation strategies to improve posttraumatic stress disorder care in rural veterans.
- Authors
Bernardy, Nancy C.; Cuccurullo, Lisa‐Ann J.; Montano, Macgregor; Bowen, Michelle; Breen, Kristen; Matteo, Rebecca; Cole, Bernard
- 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.
- Subjects
TREATMENT of post-traumatic stress disorder; HEALTH services accessibility; PSYCHOTHERAPY; BENZODIAZEPINES; MEDICAL quality control; HUMAN services programs; MEDICAL care of veterans; MENTAL health; RESEARCH funding; UNITED States. Dept. of Veterans Affairs; MEDICAL care; TRANQUILIZING drugs; POLYPHARMACY; DESCRIPTIVE statistics; RURAL conditions; VETERANS; PHYSICIAN practice patterns; QUALITY assurance; HEALTH equity; EVIDENCE-based medicine; DRUG prescribing; ACCESS to information
- Publication
Journal of Rural Health, 2024, Vol 40, Issue 3, p411
- ISSN
0890-765X
- Publication type
Article
- DOI
10.1111/jrh.12790