Intensive Outpatient PTSD Program Linked to Fewer ED Visits

Randy Dotinga

June 03, 2022

NEW ORLEANS — Adult patients who completed an intensive outpatient program (IOP) for post-traumatic stress disorder were significantly less likely over the following year to require inpatient or emergency psychiatric treatment, according to a new study released at the annual meeting of the American Psychiatric Association.

In an analysis of 256 individuals, over the 12 months before they joined the IOP, 28.7% and 24.8% had inpatient and emergency department encounters, respectively, according to the researchers. Afterward, those numbers fell to 15.9% (P < .01) and 18.2% (= .04), respectively.

"Engagement in IOP for patients with PTSD may help avoid the need for higher levels of care such as residential or inpatient treatment," Nathan Lingafelter, MD, a psychiatrist and researcher at Kaiser Permanente in Oakland, Calif., said in an interview.

Lingafelter described IOP programs as typically "offering patients a combination of individual therapy, group therapy, and medication management all at an increased frequency of about 3 half-days per week. IOPs are thought to be helpful in helping patients with severe symptoms while they are still in the community — i.e., living in their homes, with their families, occasionally still working at reduced time."

While other studies have examined the effects of IOP, "the existing literature focuses on how IOP reduces symptoms, rather than looking at how IOP involvement might be associated with patients utilizing different acute care resources," he said. "Prior studies have also been conducted mostly in veteran populations and in populations with less diversity than our population in Oakland."

For the new study, researchers tracked 256 IOP participants (83% female; mean age = 39; 44% White, 27% Black, 14% Hispanic, and 7% Asian). The wide majority — 85% — had comorbid depressive disorders.

"Patients are assigned a case manager when they enter the program who they can meet with individually, and they spend time attending group therapy sessions. Patients are also able to meet with a psychiatrist to discuss medications," Lingafelter said. "A major component in both the group and individual therapy is helping patients identify which kind of interventions work for them and what we can do now that will help. IOP can really help clarify for patients what their trauma responses are and how to start treatments that actually fit their symptoms."

The subjects had a mean 0.3 psychiatric encounters in the year before joining the program and 0.2 in the year after (< .01). Their mean emergency department visits related to mental health fell from 0.5 to 0.3 (= .03).

The study has limitations. Participants took part in IOP therapy from 2017 to 2018, before the pandemic disrupted mental health treatment. It does not examine whether medication use changed after IOP treatment. It is retrospective and doesn't confirm that IOP had any positive effect.

Multiple Benefits of IOP

In an interview, Deborah C. Beidel, PhD, director of UCF RESTORES at the University of Central Florida, Orlando, said IOP has several advantages as a treatment for PTSD. Her clinic, which focuses on PTSD treatment for military veterans, has used the approach to treat hundreds of people.

Dr Deborah Beidel

"First, IOPs can address the stigma that surrounds mental health treatment. If you have a physical injury, you take time off from work to go to physical therapy, which is time-limited. If you have a stress injury, why not do the same? Take a few weeks, get it treated, and get back to work," she said. "The second reason is that the most effective treatment for PTSD is exposure therapy, which is more effective when treatment sessions occur in a daily as opposed to a weekly or monthly time frame. Third, from a cost and feasibility perspective, an intensive program could reduce overall medical costs and get people back to work sooner."

The new study is "definitely useful" since it examines the impact of IOP over a longer term, Beidel said. This kind of data "can influence policy, particularly with insurance companies. If we can build the evidence that short, intensive treatment produces better long-term outcomes, insurance companies will be more likely to pay for the IOP."

The University of Central Florida program is funded by federal research grants and state funding, she said. "When we calculate the cost, it comes to about $10,000 in therapy time plus an average of about $3,000 in travel related costs — transportation, lodging, meals — for those who travel from out of state for our program."

What's next? "Further study is needed to characterize whether these findings are applicable to other practice settings, including virtual treatment programs; the long-term durability of these findings; and whether similar patterns of reduced resource use extend to non–mental health-specific care utilization," said Lingafelter, the study's lead author.

No study funding and no author disclosures were reported. Beidel disclosed IOP-related research support from the U.S. Army Medical Research and Development Command–Military Operational Medicine Research Program.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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