3 - (SYM 27) Implementing Brief Evidence-based PTSD Treatment in Primary Care Clinics: Provider Perspectives on Challenges and Opportunities

Approximately 25% of Veterans in primary care settings suffer from posttraumatic stress disorder (PTSD; Spottswood et al., 2017). Despite robust evidence for the efficacy of trauma-focused evidence-based psychotherapies (EBPs), Veterans rarely receive an adequate course of treatment within specialty care settings (Hale et al., 2019). Thus, adapting PTSD EBPs to fit the primary care setting is an important step toward reaching those with mental health need. As part of a national initiative that has trained over 400 rural Primary Care Mental Health (PCMHI) providers in an adapted PTSD EBP, PE for Primary care (PE-PC), we interviewed 22 providers on determinants of PE-PC in PCMHI. Participants were interviewed prior to and following implementation. Interview guides were based on CFIR 2 (Damschroder et al., 2022) and analyzed using rapid analysis (Nevedal et al., 2021). Participants believed PE-PC met the needs of their patients well, especially patients with high motivation, milder symptom presentations, and those with fewer comorbidities. Some thought that PE-PC might not be as well suited to those with recent traumas. They viewed PE-PC as a flexible option that could either stand alone or serve as a “stepping stone” to additional trauma-focused care. They found it particularly helpful to be able to provide PE-PC when there was a long wait to get into specialty care. The most commonly cited challenges were patient engagement in therapy and keeping sessions to a 30 minute time limit. Some providers wanted more guidance about who was an appropriate candidate for PE-PC. Our findings suggest that implementation efforts will need to focus on making this intervention fully compatible with the PCMHI model and proactively identifying individuals who could benefit from PE-PC versus those who should be referred directly to specialty mental health.