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Explore the American Legion-DRC survey findings on PTSD & TBI treatments, CAM options, and treatment fidelity insights for better veteran care models.
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The American Legion Survey of Patient Healthcare Experiences Jeff Greenberg, Ph.D. Data Recognition Corporation (DRC) Institute for the Advancement of Military and Veteran Healthcare
Introduction • Data Recognition Corporation (DRC) is a large, woman-owned business which focuses on survey and healthcare research, educational testing, and document production. • Jeff Greenberg, Ph.D., Senior Director of Research and Director of the DRC Institute for the Advancement of Military and Veteran Healthcare, is a clinical psychologist who completed his training in the Boston VA system, the National Center for PTSD, Harvard University Medical School, and Boston University Medical School.
Introduction • Dr. Greenberg is a researcher whose focus has been on Military and Veteran mental healthcare, posttraumatic stress disorder (PTSD), Traumatic Brain Injury (TBI), complex co-occurring disorders, depression, anxiety, substance abuse, suicide, and healthcare quality and fidelity. • Dr. Greenberg has published on PTSD and TBI and depression amongst Military and Veteran populations. He has served as a subject matter expert for Navy Medicine and DoD Medicine, where he has focused and advised senior leaders on mental health, clinical care, training, and policy.
Overview of the Survey • Collaboration between the American Legion and Data Recognition Corporation (DRC) • Exploratory research regarding • Type of care patients report receiving for PTSD and TBI • Patients’ perceptions of effectiveness of treatment • Patients’ reports of access to a range of treatment options, including Complementary and Alternative Medicine (CAM) • Quick turnaround study • First step in long-range program to encourage treatment options and fidelity to treatment protocols
Need for the Research • Limited information on types of treatment Veterans receive • Limited research documenting fidelity to treatment models • Limited knowledge about use of CAM • Limited evidence of effectiveness of CAM
Purpose of the Survey • To obtain a snapshot of what treatments Veterans are receiving and how they perceive them; and • To obtain information to help guide more rigorous, in-depth research to support the establishment of treatment models and an eventual system of fidelity modeling.
Methodology • Web survey (opt-in) • Content: demographics, treatment received, access to CAM, perceived change in symptoms and reasons for treatment termination • Press releases and social marketing to recruit respondents • 30-day field period • Analysis: frequencies and other descriptive statistics
Key Findings • Respondents reported common symptoms: Elevated Anger, Pain, Sleep Problems, Anxiety, Depression and Irritability. • For PTSD, individuals are receiving multiple therapy types with fewer than a quarter of respondents receiving treatment in conformity to DoD/VA evidence-based practice models of care.
Key Findings (continued) • For TBI, individuals are receiving a wide array of treatment types. • Medication appears to be the front line treatment reported by respondents. • A sizable proportion of respondents reported prescriptions of up to 10 medications for PTSD/TBI across their treatment experience.
Key Findings (continued) • Broadly, respondents reported limited change following treatment for PTSD and TBI: • Following therapy, the majority of respondents reported no change or worsening of symptoms; • Following medication, a slight majority reported no change or worsening of symptoms; and • In general, approximately half of all respondents reported no change or minimal improvement in symptoms.
Key Findings (continued) • Nearly half of all respondents had discussed some type of CAM-based treatment with their providers. • Respondents reported numerous types of CAM treatments, especially Meditation, Relaxation, and Stress Reduction.
Key Findings (continued) • 30 percent of respondents indicated they had terminated treatment prior to completion. • An array of rationales for treatment termination were reported. • In declining order, the rationales cited were: Lack of Improvement, Side Effects, Dissatisfied with Provider, Solve Problems on My Own, Time Burden or Distance to Treatment, and Stigma
Survey Response • 14,734 views overall, with nearly 480 per day • 3,209 starts • 3,116 completions (nearly 22 percent of viewers became completers) • 17-minute average completion time • 98 percent of completers in the United States • 74 percent used laptop,16 used percent smart phone, 10 percent used tablet • 97 percent Veteran, 3 percent spouse or other
Level of Perceived Improvement 10 point Likert scale: 1= I got worse, 5 = No change, and 10 = I got better
Symptom Change Following Therapies N = 2,309 (41% report improvement and 59% report no change or worsened)
Symptom Change Following Medication N = 2,212 (48% report improvement and 52% report no change or worsened)
Recommendations • To establish a knowledge base on the care of Veterans with PTSD and TBI, a multi-step program of research is needed over a period of years: • Establishment of baseline date, building on information gathered here, but probing more deeply and capturing data suitable for correlations and statistical modeling; • Surveys to track progress over time; • Funding of demonstration programs to test effectiveness of alternative treatments and to generate best practices and models of care as well as update practice guidelines with new findings; and • Establishment of system for monitoring and evaluating fidelity of care.
Recommendations (continued) • Simultaneously, a second track of research and development is needed to ensure the availability of a trained work force prepared to treat PTSD and TBI. That will entail steps parallel to the development of models of care: • Ancillary research on professional development related to treatment of PTSD and TBI; • Development of professional standards and collaboration with schools to build curricula that support standards of care; • Establishment of a National Advisory Group to plan the multi-step research program; and • Regular tracking surveys.
Next Steps • Establish a National Advisory Group to plan the multi-step research program. • Refine survey design in preparation for collection of baseline data and tracking surveys.
Timeline • FY 2015: Establish National Advisory Group. • FY 2016: Begin Research: • Conduct Research to Establish Baseline on Treatment of PTSD and TBI; and • Conduct Research on Professional Development. • FY 2017: • Announce 3-Year Demonstration Program; and • Establish Work Group to Collaborate with Professional Schools. • FY 2018: First Tracking Survey.
Timeline (continued) • FY 2020: Second Tracking Survey. • FY 2021: Establish Practice Guidelines/Models of Care. • FY 2022: Establish Monitoring and Evaluation System to Measure Fidelity to Models of Care, Examining both Treatment Provided and Professional Development of Health Care Providers. • FY 2022 and Beyond: • Continue Bi-annual Tracking Surveys/Integrate with Monitoring. • Process for Ongoing Integration of Tested Innovations.
