Patient Outcome Reporting for Timely Assessments of Life with Post-Traumatic Stress Disorder
Principal Investigator: Neda Laiteerapong
Traumatic stress and post-traumatic stress disorder (PTSD) are highly prevalent. Nearly all (90%) people experience at least one traumatic event in their lifetime, and 8% develop PTSD, a syndrome of at least 1-month of intrusion, avoidance, alterations in cognition and mood, and alterations in arousal and reactivity after experiences of trauma associated with significant distress or impairment. People residing in sociocultural environments entrenched in community violence are at a higher risk for PTSD, even without direct experiences of trauma. The lifetime consequences of PTSD are large, including an increased risk of other psychiatric disorders, substance use disorders, cardiovascular disease, and early mortality.
The first step to improving health outcomes for people with PTSD is identifying people who meet diagnostic criteria for PTSD. Current practices for identifying PTSD are subject to bias because diagnosis depends on clinician- or patient-initiated discussion of trauma-related symptoms. Stigma, knowledge, time, and access to resources are often barriers to these discussions. Systematic screening protocols can help address bias in who is screened, and validated screening tools can risk stratify the severity of symptoms to ascertain which people would most likely benefit from mental health treatments. In socially disadvantaged populations where rates of PTSD may be high, introducing routine screening for PTSD with linkage to care may improve the mental and physical health of those screening positive.
A keystone to screening for PTSD could be to screen patients when they are at clinic visits. For other mental health conditions, it is becoming commonplace to do screenings during primary care visits. The United States Preventive Services Task Force recommends routine screening for depression, and now anxiety. No similar recommendation exists for PTSD screening, but clinics who serve patients at a high risk for PTSD, for example, the Veterans Affairs, have implemented screening at clinic visits. In the civilian setting, PTSD screening could also be beneficial in clinics serving predominantly racially/ethnically minority patients at Federally Qualified Health Centers (FQHCs), which are a major part of the U.S. primary care safety net and are often located in socioeconomically disadvantaged areas.
Use of patient portals provide another promising strategy to address structural barriers to PTSD screening. Portals are secure websites that give access to health information and allow for patient-provider communication and screening outside of clinic visits. Prior studies have demonstrated that patients with PTSD have high interest in using smartphone apps and portals to manage their mental health. In our previous work, we used a population health approach to screen for and assess depression symptoms, employing the patient portal as a tool to reach out to patients. We found that it resulted in a higher screening rate and identified more patients with moderate-severe depression. Implementing a population-level screening approach for PTSD using the portal may be highly effective for improving identification of patients in need of PTSD treatment.
After identifying patients with PTSD, the next necessary step is to provide evidence-based treatments, like integrated primary-care behavioral health (PCBH). Integrated primary care-behavioral health (PCBH) is a model of care in which the behavioral health and primary care teams are collocated with the primary care team and work together to address the biopsychosocial factors that are affecting a patient’s health. PCBH has been found to be less stigmatizing for patients with PTSD and models of care that are proactive and provide telephonic care management have been found to increase treatment engagement for PTSD. Thus, coupling screening for PTSD with a PCBH model may be a highly effective strategy to improving PTSD outcomes.
Our goal is to implement and evaluate a more timely approach to PTSD diagnosis and management, entitled Patient Outcome Reporting for Timely Assessments of Life with Post-Traumatic Stress Disorder (PORTAL-PTSD) in a primary care setting with a high prevalence of trauma, specifically the South Side of Chicago.
Community Partner: Chicago Family Health Center