Posttraumatic Stress Disorder Collaborative Care: A Quality Improvement Study in Veterans Affairs Primary Care

Introduction: Collaborative care improves depression and anxiety outcomes. In this naturalistic, observational case study, we adapted an evidence-based depression collaborative care protocol for the assessment and treatment of posttraumatic stress disorder (PTSD) and sought to demonstrate that the protocol could be implemented in Veterans Affairs (VA) primary care. Method: Based on feedback from a content expert panel, clinical stakeholders, and a pilot study conducted in a postdeployment clinic, the original depression collaborative care protocol was modified to include PTSD assessment and support for PTSD medication adherence, self-management, and engagement in evidence-based PTSD care. Results: The modified program was implemented from November 2012 to March 2017, and 239 patients with PTSD were referred. Nearly two thirds (n = 185) enrolled, and they participated in the program for an average of 4 to 5 months and completed calls approximately once per month. Among patients with more than one assessment of clinical outcomes, 53.4% (n = 94) reported clinically significant improvement in depression on the Patient Health Questionnaire-9 ([greater than or equal to] 5-point decrease), and 42.2% (n = 35) reported clinically significant improvement on the PTSD Checklist ([greater than or equal to] 10-point decrease). Veterans and clinical staff described the modified collaborative care program positively in qualitative interviews. Discussion: Our findings suggest that a depression collaborative care program can be modified to support treatment of PTSD in primary care. The modified program was acceptable to both veterans and clinical staff and showed potential for positive clinical change in an uncontrolled quality improvement study. Public Significance Statement In this naturalistic, observational case study conducted at a major Veterans Affairs healthcare system, we adapted an evidence-based depression collaborative care protocol to assess and treat posttraumatic stress disorder (PTSD) in primary care. Both patients and clinical staff described the modified protocol in positive terms. Patients engaged in collaborative care at high levels and reported reductions in depression and PTSD symptoms. Keywords: veterans, primary care, collaborative care, care management, PTSD