Institute of Medicine report recommends improving access to care and outcomes tracking for PTSD

While many efforts are being made to reduce barriers to PTSD care, a new report said that obstacles still remain at the patient, provider and organizational levels.

Posted Aug. 1, 2012

A recently released Institute of Medicine report examined U.S. Department of Defense and Veterans Affairs (VA) programs for preventing, identifying and treating post-traumatic stress disorder (PTSD) and recommended that service members and veterans receive more timely access to evidence-based care, including PTSD screening at least once a year. The report also recommends that agencies better track treatments and outcomes, widely disseminating the findings to improve health. 

Of the U.S. service members and veterans who have served in Iraq and Afghanistan and been screened for PTSD symptoms, the report found that only about 40 percent have received referrals for additional evaluation or treatment. Of those referred, about 65 percent go on to receive treatment. An expansion of services is especially needed for individuals in rural areas, in the National Guard or Reserves, and in combat zones.

Ken Kizer
Kenneth Kizer

The report, Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment, is the first of two analyses to inventory PTSD services in anticipation of the increasing numbers of veterans returning from duty in southwest Asia who may need care. Today's report was conducted at the request of Congress and sponsored by the defense department. It is authored by the Committee on the Assessment of Ongoing Efforts in the Treatment of Post-Traumatic Stress Disorder, which includes some of the nation's foremost leaders in veterans health care. Kenneth W. Kizer, former VA under secretary for health and director of the Institute for Population Health Improvement at UC Davis Health System, is a member of the committee.

"The Department of Defense 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 at the Mailman School of Public Health of Columbia University. 

While the Department of Defense and VA are making efforts to reduce barriers to care, the committee found that obstacles still remain at the patient, provider and organizational levels. For example, patients may not seek care because they believe it may adversely affect their military careers, because of difficulties in traveling long distances to consult with mental health-care providers or the lack of flexibility in taking time off from duties or work. Health-care providers may feel that they lack specialized training or have inadequate time for treatment sessions. They also face difficulties reaching soldiers in combat zones and restrictions on when and where PTSD medications can be used.

For the next phase of the PTSD study, the committee asked the agencies to collect outcomes data on barriers to care and effective interventions, including the adherence to established PTSD clinical practice guidelines and use of complementary and alternative therapies. It also recommended that the agencies support research on the use of telemedicine and other emerging technologies to improve access and on the neurobiology of PTSD to foster the development of new approaches for prevention, screening, diagnosis and treatment.