Optimizing Pain Treatment Interventions: Improving Opioid Safety in Veterans Using Collaborative Care and Decision Support: The OPTI Study
In this randomized controlled trial, we enrolled 100 veterans with chronic pain in primary care who are prescribed opioid medications for chronic pain and exhibit at least one “high-risk” opioid use behavior. This study aims to evaluate the effectiveness of Collaborative Care/Motivational Interviewing on pain management and opioid risk.
Integrating Mental Health and Primary Care Services for OEF/OIF Combat Veterans with PTSD and Co-morbid Disorders: Assessing the Evidence
A new “OEF/OIF Integrated Care Clinic” was recently established at the San Francisco VA Medical Center to provide “one-stop” primary care, mental health and social services in an effort to improve access to mental health treatment for OEF/OIF veterans. This study aims to evaluate the effectiveness of integrated, co-located primary care, mental health and social services to enhance mental health utilization among OEF/OIF veterans, as compared to usual primary care. This study is a retrospective study using pre-existing clinical data.
Integrating Mental Health and Primary Care Services for OEF/OIF Combat Veterans with PTSD and Co-morbid Disorders: Clinicians’ Knowledge, Attitudes, & Beliefs
Primary care and mental health providers are an integral part of assessing the efficacy of the San Francisco VA “OEF/OIF Integrated Care Clinic.” We interview clinicians in order to 1) explore clinicians’ knowledge, attitudes, & beliefs about patient, system, and provider-level aspects of providing high quality care and 2) elicit descriptions of their perceived barriers to and facilitators of providing care in both the integrated care and usual care clinic types.
Does Integrating Primary Care and Mental Health Services Improve Mental Health Services Utilization, Symptoms, and Functioning Among OEF/OIF Veterans? The VICTORS Study
The goal of this prospective study is to evaluate whether integrated primary care, mental health and social work services, compared to primary care as usual, enhances use of mental health services and improves mental health symptoms, functional status and patient satisfaction among OEF/OIF veterans. We speak with OEF/OIF veterans enrolled in integrated care versus usual primary care by telephone and in focus groups to compare barriers to care, level of satisfaction with care and specific needs and preferences for care in each clinical setting.
Neuropsychological Screening of OEF/OIF Veterans in VA Primary Care
The long-term goal of this study is to promote early, accurate detection of and triage for current physical, cognitive, and mental health symptoms in OEF/OIF veterans to prevent long-term disability. The short-term goal of this proposal is to investigate the extent to which the VA TBI screening process may fail to detect or accurately identify the source of cognitive dysfunction and other postconcussive symptoms, limiting VA clinicians’ ability to optimally communicate, triage and provide targeted services for OEF/OIF veterans.
This study is a secondary data analysis that will use VA national-level traumatic brain injury (TBI) screen data which may be linked to other national VA databases. Thus, among OEF/OIF veterans using VA healthcare, we intend to provide national estimates of:
Neuropsychological Screening of OEF/OIF Veterans in VA Primary Care: A Retrospective Secondary Data Analysis
- The prevalence of cognitive symptoms in the context of a positive TBI screen
- The association of mental health diagnoses with positive TBI screens and among veterans with positive TBI screens, a comparison of the association of cognitive symptoms with mental health diagnoses and TBI history (as determined on second-level evaluation).
- Predictors of failure to keep appointments for second-level TBI evaluations in veterans with a positive first-level TBI screen.
Online PTSD Diagnosis and Treatment Training for Primary Care Physicians
Patients with posttraumatic stress disorder (PTSD) symptoms frequently present first to primary care providers (PCPs). Most PCPs have not been trained to assess for and manage symptoms of PTSD. Web-based programs are increasingly used for medical education, but there are no published evaluations of online PTSD training for PCPs.
The main aim of this project was to develop and pilot test a brief online PTSD training program for PCPs to increase their ability to detect and begin to manage PTSD symptoms in their patients exposed to trauma.
Motivational Interviewing to Engage OEF/OIF Veterans in Mental Health Treatment
Many returning Iraq and Afghanistan veterans return from war with mental health problems such as PTSD, depression and substance abuse problems. There are many barriers to war veterans seeking and accepting mental health care.
The main goal of this study was to pilot test the telephone delivery of a technique known as “Motivational Interviewing”. Experienced study staff reached out to veterans by phone to conduct rapid screening for post-deployment mental health problems and provide feedback about screen results. Then, if the participating veteran was randomized to receive Motivational Interviewing, over the course of several telephone sessions, study staff would use Motivational Interviewing techniques to help veterans overcome their personal barriers to care. Motivational Interviewing was compared to neutral telephone check-in calls among veterans who were randomized to the Control condition.
We found that the use of telephone Motivational Interviewing significantly improved the rate with which combat veterans engaged in mental health treatment both at VA and in their communities. In a new study, we will expand the use of Motivational Interviewing to reach out to rural veterans to help them in engage in mental health care that is feasible for them and best meets their needs.