Collaborative Care for Returning Veterans

Christopher J Miller

doi:10.4172/2167-1044.1000134

Abstract

Background: Treatment of Returning Veterans (RVs) involves heterogeneous challenges including post traumatic stress disorder, traumatic brain injuries, and substance dependence. Individual RVs fall along a diagnostic and functional spectrum ranging from remarkably resilient to extremely impaired. Successful treatment requires systems capable of managing such complex, varied presentations and may require adaptations to meet the needs of this population. The Collaborative Chronic Care Model (CCM) may be useful in this regard. Methods: We interviewed 20 staff members at a large urban VA medical center who care for RVs to determine strengths and areas for improvement. We used qualitative methods to assess whether the CCM could be applied to organize care to serve RV needs and prevent chronicity. Results: Analysis of interview data and fit of emergent themes to CCM elements led to consensus that the CCM was likely to be an effective framework for organizing care of RVs provided certain adaptations are made. Need for adaptation was based on analysis of themes that did not match to CCM elements. Of these, “Unique Characteristics of RVs” and “Patient Engagement” were judged to be most essential to informing adaptations to the CCM. Conclusion: Results show the CCM as likely to be an effective method of organizing care for this non-chronic population if expanded emphasis is placed on understanding unique population characteristics as a means of fostering patient engagement. Follow-up studies using RVs and other non-chronic populations as primary sources and testing of hypotheses at multiple sites would further clarify meaning and generalizability of these findings.

Highlights

2.4 million Americans have deployed in support of Operations Iraqi Freedom, Enduring Freedom, and New Dawn [1]
The major objectives of this study were: (1) to assess the current state of care for Returning Veterans (RVs) in the system under study by identifying emergent themes from interviews of clinicians and staff members working with RVs at a large, urban Veterans Affairs medical center, and (2) to gauge the relevance of the Chronic Care Model (CCM) framework for treatment and preventing onset of chronicity in populations such as RVs who present with Posttraumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), pain, and other co-morbidities
Given the study objective of assessing fit of the CCM for treatment of and preventing chronicity in RVs, we attempted to match each theme to a CCM element

Summary

Introduction

2.4 million Americans have deployed in support of Operations Iraqi Freedom, Enduring Freedom, and New Dawn [1]. The long-term wellbeing of Returning Veterans (RVs) depends greatly on access to systems of care capable of addressing conditions such as Posttraumatic Stress Disorder (PTSD) before they become chronically disabling Such care involves some challenges unique to the RV cohort: many present with some combination of PTSD, Traumatic Brain Injury (TBI), chronic pain, and Substance Use Disorders (SUDs) [2,3], and it is less common for an RV to present with one of these conditions than with two or more [4]. We must address significant difficulties with engaging and retaining RVs in treatment [3,5] The sum of these challenges makes it necessary to consider adapting systems of care delivery to meet RV needs [3]. The Collaborative Chronic Care Model (CCM) may be useful in this regard

Objectives

Methods

Results

Discussion

Conclusion