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Stepped Collaborative Care for Survivors of Acute Trauma
Am Fam Physician. 2005 Feb 15;71(4):798.
In the United States, approximately 2.5 million persons suffer severe traumatic injuries resulting in inpatient hospitalization every year. These patients have an increased risk for developing post-traumatic stress disorder (PTSD) and a higher incidence of current or lifetime alcohol abuse or dependency. Although multiple strategies can reduce the likelihood of developing PTSD, treat the symptoms of PTSD, or reduce the consumption of alcohol in these patients, the interventions are fragmented, and many patients do not receive mental health treatment during the post-injury period. Over the past few years, the concept of collaborative care, which folds disease management, pharmacotherapy, and psychotherapy into the medical management of patients, has been developed.
The goal of collaborative care is to integrate mental health care with general medical care. Zatzick and colleagues evaluated the effectiveness of a multifaceted collaborative care intervention for PTSD and alcohol abuse in acutely injured trauma survivors.
The randomized effectiveness trial recruited patients 18 years and older from a level 1 trauma center in the United States. Patients were assigned randomly to receive collaborative-care intervention (n = 59) or usual care (n = 61). The collaborative-care intervention consisted of continuous post-injury case management, motivational interviews targeting alcohol abuse or dependence, and evidence-based pharmacotherapy/cognitive behavior therapy in patients with persistent PTSD three months after injury. Assessment for PTSD was accomplished with the PTSD Checklist at baseline and again at months 1, 3, 6, and 12 after injury, while the Composite International Diagnostic Interview was used to evaluate alcohol abuse/dependency at baseline and months 6 and 12 after the injury.
There were no significant differences in demographics, types of injuries, or clinical characteristics of patients in the collaborative-care group and patients in the usual-care group. With regard to PTSD and alcohol abuse/dependency, the patients receiving collaborative care had significantly fewer symptoms than patients in the usual-care group. The collaborative-care group showed no change in PTSD symptoms from baseline to 12 months, while the usual-care group showed a 6 percent increase in PTSD symptoms during the study. There was a 24 percent average reduction in alcohol abuse/dependency in the collaborative-care group, while the usual-care group had a 13 percent increase.
The authors conclude that early mental health care interventions are feasible and effective in patients who suffer acute trauma. They note that the stepped collaborative care approach provides high-quality post-traumatic care by tailoring the interventions to the needs of the patient and delivering evidence-based mental health care.
Zatzick D, et al. A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. Arch Gen Psychiatry. May 2004;61:498–506.
Copyright © 2005 by the American Academy of Family Physicians.
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