The U.S. departments of Defense and Veterans Affairs should ensure that service members and veterans who have post-traumatic stress disorder (PTSD) have timely access to evidence-based care, says a new congressionally mandated report from the Institute of Medicine. Of the U.S. service members and veterans who have served in Iraq and Afghanistan and screened positive for PTSD symptoms, about 40 percent have received a referral for additional evaluation or treatment, and of those referred, about 65 percent go on to receive treatment, the report notes.
In addition to broadening patients' access to care, DOD and VA should better track the treatments given to patients as well as their outcomes, said the committee that wrote the report. The agencies should also institute research programs to evaluate the effectiveness of their PTSD programs and disseminate the findings widely. The report adds that PTSD screening should be conducted at least once a year when primary care providers see service members at DOD treatment centers or under TRICARE, as is currently done when veterans are seen in the VA system.
"DOD and VA offer many programs for PTSD, but treatment isn't reaching everyone who needs it, and the departments aren't tracking which treatments are being used or evaluating how well they work in the long term," said committee chair Sandro Galea, professor and chair of the department of epidemiology, Mailman School of Public Health, Columbia University, New York City. "In addition, DOD has no information on the effectiveness of its programs to prevent PTSD."
The report concludes the first phase of a study of DOD and VA programs to prevent, identify, and treat PTSD. However, the committee found insufficient data to judge the efficacy of many of the PTSD-related services offered by the agencies. Data has been requested and, in some cases, received from DOD and VA on numbers of service members and veterans who have PTSD, treatments they are receiving, and the outcomes and costs of those treatments. If additional data are received during the second phase of the study, the committee hopes to refine its findings and recommendations.
Although DOD and VA are making efforts to reduce barriers to care, the committee found that many obstacles remain and occur at various levels. Barriers include patients' not seeking care because of concerns that doing so will adversely affect their military career, the need to travel long distances to a mental health provider, or an inability to take time off from their duties or work to get treatment, among other reasons. Providers might find it difficult to treat patients because of lack of training or time or location issues, such as transportation in a war zone. Organizational barriers can include limited treatment opportunities in combat zones, restrictions on when and where medications for PTSD can be used, and logistical difficulties in getting service members or veterans to appointments.
The agencies should collect more data on barriers to care in order to better understand them, and any interventions used to overcome these barriers should be assessed for effectiveness, the report says. The agencies should also support research on the use of emerging technologies such as telemedicine that could improve availability and accessibility.
The committee commended DOD and VA for jointly developing a clinical practice guideline for care of PTSD but noted that there is little information on the degree to which health care providers are adhering to this guideline. Emerging treatments such as complementary and alternative therapies should be rigorously evaluated for effectiveness and cost, the report adds. And DOD and VA should support research that might help translate knowledge of the neurobiology of PTSD to new approaches for prevention, screening, diagnosis, and treatment.