In the United States, approximately...

In the United States, approximately 25 million individuals suffer severe traumatic injuries resulting in inpatient hospitalization each year. These patients have an increased risk for developing post-traumatic stres disorder (PTSD) and a higher incidence of popular or lifetime alcohol abuse or colony Although multiple strategies can shorten the likelihood of developing PTSD treat the symptoms of PTSD or lessen 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. above the past few years, the general [i]or[/i] abstract notion of collaborative care, which doubles 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 plain 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 reliance and evidence-based pharmacotherapy/cognitive behavior therapy in patients with persistent PTSD three month after injury. Assessment for PTSD was accomplished with the PTSD Checklist at baseline and again at month 1 3 6 and 12 after injury, while the Composite International Diagnostic Interview was used to evaluate alcohol abuse/ adjunct at baseline and months 6 and 12 after the injury.

There were no significant differences in demographics, stamps of injuries, or clinical characteristics of patients in the collaborative-care cluster and patients in the usual-care assign places to With regard to PTSD and alcohol abuse/dependency, the patients receiving collaborative care had significantly fewer symptoms than patients in the usual-care clump The collaborative-care group showed no change in PTSD symptoms from baseline to 12 month while the usual-care dispose showed a 6 percent increase in PTSD symptoms during the close attention There was a 24 percent average reduction in alcohol abuse/dependency in the collaborative-care dispose while the usual-care group had a 13 percent increase.

The authors determine that early mental health care interventions are feasible and effective in patients who undergo acute trauma. They note that the stepp collaborative care approach provides high-quality post-traumatic care through tailoring the interventions to the destitutions of the patient and delivering evidence-based mental health care.

Zatzick D et al. A randomized effectiveness trial of stepp collaborative care for acutely injured trauma survivors. Arch Gen Psychiatry May 2004;61:498-506

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