The Primary Care Provider's Role

Primary care practitioners play key roles in case identification, patient support, referral, treatment of associated medical problems, delivery of pharmacotherapy and overall patient management. In general, primary care providers should be expected neither to initiate pharmacological treatment nor to assume full responsibility for its management. The patient with PTSD will likely require, at minimum, a medication consult and on-going management by a psychiatrist experienced in PTSD treatment.

There is no question that medications and behavioral interventions can provide some symptomatic relief of anxiety, depression, insomnia, and other symptoms of PTSD. Timely, brief psychological assistance can prevent or greatly reduce the onset or severity of PTSD and decrease the overall cost of medical care. A working model of patient management might include the following steps:

• Identify a mental health or PTSD specialist (e.g., psychologist, social worker, psychiatric nurse, psychiatrist, community clinic, rape crisis center) that can act as a source of professional consultation, patient assessment, patient education, and psychological or psychiatric treatment.

• Administer a brief self-report or interview screen to all patients or to patients whose combat history or current signs or symptoms suggest the possible presence of PTSD (see PC-PTSD, or screening for PTSD on this website).

• For those patients who screen likely for PTSD, establish a plan for referral to the identified specialist or clinic. The medical provider should then ensure that the patient complies with this crucial part of his or her treatment plan.

An equally critical step is to maintain on-going contact with the mental health or PTSD specialist in order to monitor the patient's compliance and responses to mental health intervention.