Impact and Efficiency of Treatment Across Two PTSD Clinical Trials Comparing In-Person and Telehealth Service Delivery Formats

• Published in: Psychological services 2024-02, Vol.21 (1), p.73-81
• Main Authors: McGeary, Cindy A., Morland, Leslie A., Resick, Patricia A., Straud, Casey L., Moring, John C., Sohn, Min Ji, Mackintosh, Margaret-Anne, Young-McCaughan, Stacey, Acierno, Ron, Rauch, Sheila A. M., Mintz, Jim, McGeary, Donald D., Wells, Stephanie Y., Grubbs, Kathleen, Nabity, Paul S., McMahon, Chelsea J., Litz, Brett T., Velligan, Dawn I., Macdonald, Alexandra, Mata-Galan, Emma, Holliday, Stephen L., Dillon, Kirsten H., Roache, John D., Peterson, Alan L.
• Format: Article
• Language: English
• Subjects: Adult; Behavior modification; Clinical research; Clinical trials; Cognitive Behavior Therapy; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive-behavioral factors; Efficiency; Female; Health Care Delivery; Human; Humans; Male; Males; Patients; Post traumatic stress disorder; Posttraumatic Stress Disorder; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Telemedicine; Telemedicine - methods; Treatment Outcome; Treatment Outcomes; Veterans; Veterans - psychology
• ISSN: 1541-1559; 1939-148X; 1939-148X
• DOI: 10.1037/ser0000774

The intent of this study is to examine treatment impact and efficiency observed when cognitive behavioral treatments for posttraumatic stress disorder (PTSD) are delivered in-person or using telehealth. This study pooled data from 268 veterans enrolled in two PTSD clinical trials. In both trials, treatment was delivered using in-home telehealth (telehealth arm), in-home in-person (in-home arm), and in-office care, where patients traveled to the Department of Veterans Affairs for either office-based telehealth or office-based in-person care (office arm). Average age was 44 (SD = 12.57); 80.9% were males. The PTSD Checklist for DSM-5 (PCL-5) was used to assess symptom severity. Treatment impact was measured by (a) the proportion of participants who completed at least eight treatment sessions and (b) the proportion with a reliable change of ≥10 points on the PCL-5. Treatment efficiency was measured by the number of days required to reach the end point. The proportion of participants who attended at least eight sessions and achieved reliable change on the PCL-5 differed across treatment formats (ps < .05). Participants in the in-home (75.4%) format were most likely to attend at least eight treatment sessions, followed by those in the telehealth (58.3%) and office (44.0%) formats, the latter of which required patients to travel. Participants in the in-home (68.3%, p < .001) format were also more likely to achieve reliable change, followed by those in the telehealth (50.9%) and office (44.2%) formats. There were no significant differences in the amount of time to complete at least eight sessions. Delivery of therapy in-home results in a significantly greater likelihood of achieving both an adequate dose of therapy and a reliable decrease in PTSD symptoms compared to telehealth and office formats. Impact Statement The greatest opportunity for response to cognitive behavioral therapies for posttraumatic stress disorder (PTSD) is when patients receive an adequate dose of therapy. This study demonstrated that when treatment is delivered in-home in-person, participants are most likely to receive an adequate dose of therapy and are more likely to experience a reliable decrease in PTSD symptoms compared to telehealth and office-based delivery of care.