Integrated Post-Traumatic Stress Disorder (PTSD) Screening in Primary Care in a Civilian Population: A Pilot Approach

Post-traumatic stress disorder (PTSD) among civilians is a significant contributor to healthcare costs and functional impairment in the United States. While approved evidence-based treatments exist, underdiagnosis and care navigation remain barriers to treatment access. Integrated care models may potentially address these barriers by centralizing screening, diagnosis, and treatment delivery within primary care. Here, we describe a mixed-methods clinical process improvement analysis to determine the impact of implementing the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), an instrument validated in primary care populations, in a primary care clinic with an embedded Collaborative Care Model (CoCM). Screening is naturalistic to clinic workflows and targeted to patients first scoring 10 or greater on a Patient Health Questionnaire 9 Question (PHQ-9) or Generalized Anxiety Disorder Assessment (GAD-7). The analysis will consist of pre- and post-implementation investigation of process, patient, and healthcare provider (HCP)-related outcomes through phases of staff training and change management. Prospective chart review will determine screening and diagnosis rates and population demographics, referral/treatment pathways (e.g. external vs. CoCM-based interventions), and symptom improvement outcomes. Structured qualitative interviews and quantitative surveys will assess changes in HCP attitudes regarding identification, management, and delivery of medical and psychiatric care for primary care patients with symptomatic PTSD. The results of this study will add to a growing body of literature regarding effective health system-based interventions to improve PTSD treatment for civilian patients and exemplify the potential role of primary care in driving expanded access.