Stakeholder Experiences in a Stepped Collaborative Care Study Within U.S. Army Clinics

Published in: Psychosomatics, 2016

Posted on RAND.org on July 05, 2016

by Caroline Batka, Terri Tanielian, Mahlet Atakilt Woldetsadik, Carrie M. Farmer, Lisa H. Jaycox

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Research Questions

  1. What are the experiences of health care providers, care facilitators, and patients with integrating treatment for PTSD and depression within primary care clinics in the U.S. Army, using care facilitation, and the specific therapeutic tools used within the STEPS UP study?
  2. How do these stakeholders view the collaborative care approach?

Objective

This paper examines stakeholder experiences with integrating treatment for PTSD and depression within primary care clinics in the U.S. Army, the use of care facilitation to improve treatment, and the specific therapeutic tools used within the Stepped Treatment Enhanced PTSD Services Using Primary Care (STEPS UP) study.

Methods

We conducted a series of qualitative interviews with health care providers, care facilitators, and patients within the context of a large randomized controlled trial being conducted across 18 Army primary care clinics at 6 military installations.

Results

Most of stakeholders' concerns clustered around the need to improve collaborative care tools and care facilitators and providers' comfort and abilities to treat behavioral health issues in the primary care setting.

Conclusions

While stakeholders generally recognize the value of collaborative care in overcoming barriers to care, their perspectives about the utility of different tools varied. The extent to which collaborative care mechanisms are well-understood, navigated, and implemented by providers, care facilitators, and patients is critical to the success of the model. Improving the design of the web-based therapy tools, increasing the frequency of team meetings and case presentations, and expanding training for primary care providers on screening and treatment for PTSD and depression and the collaborative care model's structure, processes, and offerings may improve stakeholder perceptions and utilization of collaborative care.

Key Findings

  • While perceptions varied, providers, care facilitators, and patients generally reported that the collaborative care model was valuable in offering additional pathways to care.
  • The extent to which collaborative care mechanisms are well-understood, navigated, and implemented by providers, care facilitators, and patients is critical to the model's success.
  • Behavioral health providers perceived issues with primary care providers' comfort and capability to treat both PTSD and depression, but they reported relatively more issues with PTSD. Only about a quarter of behavioral health providers indicated they believed primary care providers to be comfortable treating depression, and only a fifth of behavioral health providers believed that primary care providers are comfortable treating PTSD.
  • The role of care facilitators within the collaborative care model is essential; however, we noted some confusion among providers about how to best use these professionals.
  • The use of the phone for care management and psychotherapy seemed generally acceptable. While phone care management doesn't replace face-to-face engagement, it does provide an opportunity for quick check-ins and the provision of care in a manner that can improve access and continuity.

Recommendations

  • Improving the design of specific collaborative care tools and the training on how to use them may improve stakeholders' perceptions and institutionalized utilization of collaborative care.
  • Better description and dissemination of their care facilitators' roles may improve health care providers' willingness to use collaborative care.
  • Improving the design of the web-based therapy tools, increasing the frequency of team meetings and case presentations, and expanding training for primary care providers on screening and treatment for PTSD and depression and the collaborative care model's structure, processes, and offerings may improve stakeholder perceptions and utilization of collaborative care.

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