DOD, VA Called Out for Failing to Track PTSD Outcomes
By Caroline Cassels
Medscape Neurology
June 20, 2014.

The US Department of Defence (DoD) and the Department of Veterans Affairs (VA) fall far short when it comes to tracking treatment outcomes in service members and veterans with post–traumatic stress disorder (PTSD), according to the Institute of Medicine (IOM).

In a report released today, the IOM takes these 2 federal departments to task, describing the DoD's programs as "local, ad hoc, incremental, and crisis–driven with little planning devoted to the development of a long-range approach to obtaining desired outcomes."

The report authors note that because of a more unified organizational structure than the DoD, the VA has a more consistent approach to the management of PTSD in its medical facilities.

Nevertheless, the authors note, neither of these federal departments "knows with certainty whether those many programs and services are actually successful in reducing the prevalence of PTSD in service members or veterans and in improving their lives," despite the fact that they both spend substantial amounts of time, money, and effort trying to manage PTSD.

"Given that the DOD and VA are responsible for serving millions of service members, families, and veterans, we found it surprising that no PTSD outcome measures are used consistently to know if these treatments are working or not," committee chair Sandro Galea, MD, MPH, professor and chair of the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, said in a statement.

"They could be highly effective, but we won't know unless outcomes are tracked and evaluated," he added.

An exception to this, the committee noted, are the VA's specialized intensive PTSD programs, which do collect outcomes data. However, these programs serve only 1 percent of veterans with PTSD, and the data suggest the programs yield only modest improvements in symptoms.

The report recommends that the DOD and the VA develop, coordinate, and implement a measurement–based PTSD management system that documents patients' progress during the course of treatment, regardless of where they receive treatment, and that they conduct long–term follow–up using standardized and validated instruments.

The report authors recommend that DOD and VA leaders, who are responsible for delivering high–quality care for their populations, communicate a clear mandate through their chain of command that PTSD management, using best practices, has high priority.

The report also recommends that the DOD and the VA have an adequate workforce of mental health care providers to meet the growing demand for PTSD services, noting that although both departments have increased mental health staffing, these increases are not keeping pace with the demand for PTSD services.

Staffing shortages, the authors note, can result in clinicians not having time to provide evidence–based psychotherapies readily. In 2013, only 53 percent of veterans of the Iraq and Afghanistan wars who had a primary diagnosis of PTSD and sought care in the VA had received the recommended 8 sessions within 14 weeks.

Additional findings from the report include the following:

PTSD has increased among veterans of other eras of conflict. In 2013, 62,536 new cases of PTSD in the VA were diagnosed in veterans who did not serve in the Iraq and Afghanistan wars, and 34 percent of new admissions to VA specialized PTSD programs in 2012 were Vietnam–era veterans.

Veterans of the Iraq and Afghanistan wars use the VA at rates double those of other veterans — 54 percent of Iraq and Afghanistan war veterans use the VA vs 27 percent of all veterans.

PTSD is the third most common major service–connected disability after hearing loss and tinnitus.

In 2012, 13.5 percent of soldiers in the US Army had a diagnosis of PTSD, as did 10 percent of Marines, 4.5 percent of Navy personnel, and 4.4 percent of Air Force personnel.

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