Development of a Practice Tool for Primary Care Providers: Medication Management of Posttraumatic Stress Disorder in Vet
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Development of a Practice Tool for Primary Care Providers: Medication Management of Posttraumatic Stress Disorder in Veterans with Mild Traumatic Brain Injury Muhammad R. Baig, MD, et al. [full author details at the end of the article] # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Posttraumatic stress disorder (PTSD) and comorbid mild traumatic brain injury (mTBI) are highly prevalent in veterans who served in Iraq [Operation Iraqi Freedom/Operation New Dawn] and Afghanistan [Operation Enduring Freedom]. Complicated psychotropic medications are used for treatment of PTSD and comorbid mTBI symptoms lead to polypharmacy related complications. Primary care providers (PCPs) working in Community Based Outpatient Clinics (CBOCs) are usually burdened with the responsibility of managing this complicated medication regimen or relevant side effects. The PCPs do not feel equipped to provide this complicated psychopharmacological management. Thus, there is a need for a comprehensive yet concise tool for the medication management of PTSD in veterans with comorbid mTBI. (1) To conduct focus groups of interdisciplinary team of experts and other stake holders to assess need, (2) To carefully review current VA/ Department of Defense practice guideline to identify content, (3) To develop an evidence based, user friendly, and concise pocket guide for the PCP’s. Content was identified by review of current guidelines and available literature and was finalized after input from stakeholders, multidisciplinary team of experts, and review of qualitative data from focus groups/interviews of clinicians working in remote CBOCs. The pocket tool was formatted and designed by multimedia service. A pocket guide in the form of a bi-fold, 4″ × 5.5″ laminated card was developed. One thousand hard copies were distributed in the local VA medical center. This product is available online for download at the South-Central Mental Illness Research, Education, and Clinical Center website (https://www.mirecc.va.gov/VISN16/ptsd-andmtbi-pocket-card.asp). This pocket card provides PCPs an easy to carry and userfriendly clinical decision-making tool to effectively treat veterans with PTSD and comorbid mTBI. Keywords Pocketcard . Polypharmacy . Posttraumatic stress disorder . Mild traumaticbrain injury . Veterans
Muhammad R. Baig and Adeel Meraj contributed equally to this manuscript.
Psychiatric Quarterly
Abbreviations CBOCs CBT DSM-5 EBP FDA GABA ICD-10 IOM IR mTBI NIH OIF OEF OND PCS PE PCPs PRC PTSD SC MIRECC SNRIs SR SSRI STVHCS TBI TCAs TFT QTc UTHSCSA VA VISN VSSC XR
Community based outpatient clinics Cognitive behavioral therapy Diagnosis and statistical manual of mental disorder, Fifth Edition Evidence based psychotherapy Food and Drug Administration Gamma-aminobutyric Acid International classification of diseases, 10th Edition Institute of Medicine Immediate release Mild traumatic brain injury National Institutes of Health Operation Iraqi Freedom Operations enduring freedom Operation new dawn Post-concussion syndro
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