Trends in PTSD Diagnosis and Care Delivery among Community Health Center Patients 2019-2022

Context: Rates of PTSD have increased over the past 40 years. Major trauma exposure and development of PTSD is disproportionately higher among safety-net, medically vulnerable populations. More than 99% of health centers provide in-person and virtual behavioral health care for medically vulnerable communities, including more than 15 million mental health visits in 2021. Understanding trends and subgroups in PTSD care delivery among patients who visit health centers can support interventions to identify and manage PTSD among populations with health disparities.

Objective: To assess changes in PTSD visits in CHC patients.

Study Design and Analysis: Monthly trend of visits with a PTSD encounter diagnosis by in-person vs. telehealth, age group, race-ethnicity, and new-onset verses continuing care from 2019 to 2022.

Setting or Dataset: We used EHR data from the OCHIN network of health centers using a single instance of the Epic EHR at over 1300 CHC sites across the US. The sample included primary care CHCs with at least 500 patients in 2019.

Population Studied: The dataset included 1,581,744 patients seen at 218 health centers in 13 states. The population included 19.5% black, 35.7% Hispanic, 66.2% public insurance, 16.7% uninsured and 78.3% under 138% of the federal poverty level.

Intervention/Instrument: This is an observational study.

Outcome Measures: Encounters with a PTSD diagnosis compared to all encounters; PTSD encounters conducted via in-person or telehealth care; PTSD care delivery by context (in-person or telehealth), stratified by race/ethnicity and age category.

Results: While the number of patients with a PTSD diagnosis did not change over time, the number of visits associated with a diagnosis of PTSD increased substantially compared to encounters for all diagnoses. Telehealth as a portion of total PTSD visits increased at the onset of the COVID pandemic and remained a widespread delivery method (11.3% of all telehealth visits were for PTSD in December 2022 compared to 7.1% of April 2020 telehealth visits), the proportion of patients with PTSD the in our sample is steady as a portion of the total population.

Conclusions: Telehealth is used in the treatment of PTSD, and clearly is used widely for the treatment of that disorder in CHCs. In our sample we found that PTSD treatment as a proportion of total telehealth visits is increasing. We also found differences in use of telehealth among age groups and race-ethnicity categories.