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Psychotherapy Via Telemedicine Is Promising for Veterans With PTSD

Megan Brooks

May 3, 2011 — Telemedicine is proving to be a convenient and effective way to provide specialized one-on-one psychotherapy for veterans with posttraumatic stress disorder (PTSD), according to preliminary findings from 2 ongoing randomized controlled trials.

Zia Agha, MD, MS, director of health services research at the VA San Diego Healthcare System in California, presented the findings today in Tampa, Florida, at the American Telemedicine Association (ATA) 16th Annual International Meeting.

During a media briefing, he noted that veterans with PTSD and institutions treating them face a myriad of challenges, chief among them is access to care as a result of geographic and financial barriers.

"While we have evidence-based treatments for PTSD — cognitive processing therapy (CPT) and prolonged exposure therapy (PET) have been shown to be highly effective — they are not available to everybody; they are localized at major medical centers."

Beyond geographic barriers, another barrier unique to PTSD patients is the "fear of traveling and going into places that may be crowded," Dr. Agha said.

Boosts Adherence, Lowers Costs

Two randomized controlled trials of telemedicine for PTSD involving roughly 500 veterans with PTSD and 26 therapists are now in progress. The trials are designed to confirm the effectiveness of CPT and PET delivered via a video link vs standard in-person delivery.

So far, patients assigned to "telepsychiatry" have had far fewer cancellations than patients assigned to in-person psychotherapy (24% vs 34%), Dr. Agha reported.

"This is a really important finding because if [patients] don't come for therapy, they aren't going to get better," he said. The 'no-show' rate has also been lower with telepsychiatry than for in-person therapy (5% vs 19%). Therefore, from a purely adherence perspective, "telemedicine seems to be achieving an important outcome," Dr. Agha noted.

Although cost analyses are ongoing, Dr. Agha reported that, on average, treating 100 patients with telemedicine costs less than treating 100 patients with in-person psychotherapy ($94,000 vs $106,000).

"If you take into account the missed visits and the distance traveled and the time involved, that more than itself offsets the infrastructure and technology costs, and we haven't even factored in the quality of life," he noted.

In both formal and informal conversations, both patients and providers report high satisfaction with PTSD therapy via telemedicine.

"Initially, our providers were very hesitant about doing psychotherapy via telemedicine; they were concerned that it would not be effective, that technology would get in the way, and that patients would not like it," Dr. Agha said.

Not only are these concerns being "dispelled," therapists are also finding some "unexpected advantages" to telepsychiatry, Dr. Agha said. Some have reported they are "able to connect better with their patients because there isn't the overbearing presence in the room" and that patients talk more without interruption.

'Exciting Times'

Dr. Dale C. Alverson, MD, ATA president and medical director of the Center for Telehealth at the University of New Mexico Health Sciences Center in Albuquerque, said, "These are exciting times for telemedicine.

"These preliminary findings show that telemedicine has the potential to have a "profound influence in the lives of veterans in our country suffering from PTSD, especially those who live in rural areas," he told Medscape Medical News.

"Telemedicine technologies are a key solution to improve access to mental health services for the increasing numbers of veterans returning from the battlefield with PTSD and traumatic brain injury," added Dr. Alverson.

The studies are sponsored by the US Department of Defense and the US Department of Veterans Affairs. The study authors and Dr. Alverson have disclosed no relevant financial relationships.

American Telemedicine Association (ATA) 16th Annual International Meeting: Abstract 506. Presented May 3, 2011.