November 11, 2021
Primary care is often the first place of contact for patients who have a history of trauma, making primary care the ideal setting to both recognize and care for patients with a history of trauma. Research has shown repeatedly that Adverse Childhood Events (ACEs), defined as potential traumatic events that occur in childhood, are linked to chronic health, mental health, and substance abuse problems in adulthood. In a survey conducted across 25 states, about 61% of adults reported that they had experienced at least one type of ACE, and nearly 1 in 6 respondents reported they had experienced four or more types of ACEs.1
Since many primary care providers screen for anxiety with the Generalized Anxiety Disorder-7 (GAD7), a screening tool for anxiety, patients with post traumatic stress disorder can often be identified during screening. Primary care practices who have implemented Collaborative Care, an evidence based model that identifies and treats patients with depression and anxiety in primary care, have found that it is effective in both engaging patients into treatment and reducing their symptoms.
Collaborative Care takes a “treat to target” symptom based approach and is often effective treatment for patients with symptoms of Post Traumatic Stress Disorder (PTSD). In addition to providing primary care providers with a systemic approach to manage patients with PTSD, Collaborative Care also provides a targeted symptom reduction approach for patients, many who have been struggling with untreated symptoms for years.
Access to treatment is a particularly important issue for patients with PTSD. In fact, studies have shown that 42% of patients with PTSD do not access therapeutic services in the first year of diagnosis.2 Since most patients receive care under the umbrella of their trusted primary care provider, identifying and treating PTSD within this setting considerably increases their likelihood of accessing much needed treatment. Additionally, Collaborative Care is patient centered, progress is monitored, and interventions are adjusted as needed. The GAD7 is used consistently to drive symptom reduction, recognize strategies that foster improvement and target symptoms that are not improving. Concert Health has engaged 406 patients with PTSD in Collaborative Care with 51% having demonstrated a reduced GAD score by discharge.
Collaborative Care is an evidenced-based, accessible way to address a patient’s trauma-related symptoms in the primary care setting. Behavioral health clinicians working in this model are poised to help patients better understand and self-manage their physical and emotional symptoms. The ability to provide symptom relief to patients with PTSD gives patients a sense of control and empowerment, which may also lead to increased rates of patients seeking more comprehensive specialized treatment.
Sources:
- https://www.cdc.gov/violenceprevention/aces/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Ffastfact.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454778/