Association for Public Policy Analysis & Management

Posttraumatic Stress Disorder (PTSD) is a chronic and often debilitating condition that is prevalent among military service members and veterans and remains undertreated. Primary care is an opportune setting for connection to treatment, because veterans are more likely to raise behavioral health concerns with primary care physicians (PCPs) than to seek out specialists. Many PCPs, however, receive little training on service-related conditions or post-deployment issues. In this study, we developed a continuing medical education (CME) course for PCPs focused on promoting evidence-informed care for combat-related PTSD. We then tested the CME’s effects on PCPs’ knowledge about PTSD in the military community, confidence around providing care related to PTSD, and frequency of identifying patients with a military history.

We conducted a quasi-experimental evaluation study to assess the effects of the CME on learning outcomes. We first recruited PCPs from a national panel to complete a baseline survey assessing PCPs’ screening practices, confidence around providing PTSD-related care, and knowledge about the military population and PTSD. We then invited baseline survey completers to complete the CME. Finally, we collected follow-up survey data one month after CME completion for 258 CME completers and a matched comparison group of 538 PCPs who had completed the baseline survey but did not complete the CME. The comparison group was matched to the group of CME completers based on baseline level of PTSD knowledge and medical school graduation year, the two characteristics that differed between CME completers and non-completers and were associated with baseline outcomes. We then estimated difference-in-differences models to assess changes in outcomes between baseline and follow-up among CME completers as compared to the matched comparison group. Models included baseline characteristics as covariates to adjust for intervention-comparison differences and to improve model precision.

At baseline, less than half of PCPs very often or always asked new patients about their military status. PCPs reported moderate confidence across various activities related to providing care around PTSD. Most PCPs were knowledgeable about effective medications for treating PTSD, but demonstrated less knowledge about PTSD prevalence among service members and evidence-based screening instruments and psychotherapies. Compared to PCPs who did not complete the CME, PCPs who completed the CME had a significantly greater increase between baseline and follow-up in confidence around PTSD clinical care (4%) and in overall PTSD knowledge (7%). The CME was effective in improving knowledge and confidence across various physician groups (e.g., by practice setting). It had no significant impact on PCPs’ frequency of screening for military history.

This study demonstrated the feasibility of evaluating CMEs that are aimed at addressing current knowledge and confidence gaps and promoting evidence-based practices in primary care settings. Although this study’s CME did not impact PCPs’ screening for military history, it showed promise in improving knowledge and confidence around PTSD across a broad swath of PCPs. Primary care offices, particularly those serving high numbers of military and veteran patients, could benefit from engaging physicians to complete evidence-based CMEs to promote PTSD clinical knowledge.