{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T13:13:03Z","timestamp":1780751583551,"version":"3.54.1"},"reference-count":25,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2017,4,1]],"date-time":"2017-04-01T00:00:00Z","timestamp":1491004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Abuse"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:p>Background: Clinical guidelines for the management of posttraumatic stress disorder (PTSD) recommend against the use of benzodiazepines. Benzodiazepines and PTSD are both associated with addiction-related risks. The Department of Veterans Affairs (VA) prescribing trends show continued use of benzodiazepines and polysedative use in veterans with PTSD, particularly in rural areas. The authors examine the use of an educational intervention to improve pharmacologic management of veterans with PTSD in rural clinics. Methods: The VA Academic Detailing Service Informatics Toolset provides prescribing, demographic and risk factor data for veterans with PTSD treated at the White River Junction VA Medical Center (WRJ VA) and affiliated rural clinics in Vermont and New Hampshire. Individualized academic detailing visits were provided to clinicians identified by the informatics tool with the aim of increasing guideline-concordant care. Other educational efforts included traditional, didactic group education on evidence-based PTSD care and the development and dissemination of educational materials for clinicians and patients. Prescribing trends of benzodiazepines, off-label atypical antipsychotics, and prazosin were collected quarterly for 3 years (October 1, 2013, to September 30, 2016). Results: Prescribing rates of benzodiazepines during the educational intervention decreased from 13% to 9.3%. Use of off-label atypical antipsychotics, a class of medications not recommended for PTSD, stayed relatively flat at about 10%. Prescribing of prazosin, a medication recommended for treatment of trauma nightmares, increased from 9.8% to 14.3%. Conclusions: Academic detailing and other educational programming appear to be effective for addressing gaps and lag in quality PTSD care and are associated with a positive trend of decreased benzodiazepine use. Efforts will continue, now with added focus on concurrent use of benzodiazepines and opioids and the use of off-label atypical antipsychotics in rural veterans with PTSD.<\/jats:p>","DOI":"10.1080\/08897077.2017.1303423","type":"journal-article","created":{"date-parts":[[2017,3,9]],"date-time":"2017-03-09T14:53:59Z","timestamp":1489071239000},"page":"129-134","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Cultivating Change Door to Door: Educational Outreach to Improve Prescribing Practices in Rural Veterans with Posttraumatic Stress Disorder"],"prefix":"10.1177","volume":"38","author":[{"given":"Macgregor","family":"Monta\u00f1o","sequence":"first","affiliation":[{"name":"Veterans Affairs Medical Center, White River Junction, Vermont, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy C.","family":"Bernardy","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Veteran Affairs Medical Center, White River Junction, Vermont, USA"},{"name":"Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Sherrieb","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Veteran Affairs Medical Center, White River Junction, Vermont, USA"},{"name":"Department of Sociology, Dartmouth College, Hanover, New Hampshire, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,4,1]]},"reference":[{"key":"bibr1-08897077.2017.1303423","unstructured":"Department of Veterans Affairs. Post-traumatic Stress Disorder: VA\/DoD Clinical Practice Guideline. http:\/\/www.healthquality.va.gov\/Post_Traumatic_Stress_Disorder_PTSD.asp. Published October 2010. Accessed June 29, 2016."},{"issue":"4","key":"bibr2-08897077.2017.1303423","first-page":"CD000409","author":"O'Brien MA","year":"2007","journal-title":"Cochrane Database Syst Rev."},{"key":"bibr3-08897077.2017.1303423","first-page":"38","volume":"33","author":"Wells DL","year":"2016","journal-title":"Fed Pract."},{"key":"bibr4-08897077.2017.1303423","volume-title":"Pharmacologic Guidelines for Treating Individuals With Post-traumatic Stress Disorder and Co-occurring Opioid Use Disorders","author":"Substance Abuse and Mental Health Services Administration (SAMHSA)","year":"2012"},{"key":"bibr5-08897077.2017.1303423","first-page":"236","volume":"51","author":"Braun P","year":"1990","journal-title":"J Clin Psychiatry"},{"key":"bibr6-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E043"},{"key":"bibr7-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1097\/PRA.0000000000000091"},{"key":"bibr8-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.10m06775"},{"key":"bibr9-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201100544"},{"key":"bibr10-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-0361.2010.00294.x"},{"key":"bibr11-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2011.03563.x"},{"key":"bibr12-08897077.2017.1303423","first-page":"w13277","volume":"141","author":"Lalive A","year":"2011","journal-title":"Swiss Med Wkly."},{"key":"bibr13-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2016.1179242"},{"key":"bibr14-08897077.2017.1303423","volume-title":"The TEDS Report: Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry","author":"Substance Abuse and Mental Health Services Administration (SAMHSA)","year":"2012"},{"key":"bibr15-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2016.303061"},{"key":"bibr16-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12787"},{"key":"bibr17-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2698"},{"key":"bibr18-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-016-0063-8"},{"key":"bibr19-08897077.2017.1303423","volume-title":"FY15 Enrollment Extract File [data file]","author":"Department of Veterans Affairs","year":"2016"},{"key":"bibr20-08897077.2017.1303423","volume-title":"PTSD Informatics Toolset Definitions","author":"VA Academic Detailing Service","year":"2016"},{"key":"bibr21-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2175"},{"key":"bibr22-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1080"},{"key":"bibr23-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2016.15070967"},{"key":"bibr24-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000245"},{"key":"bibr25-08897077.2017.1303423","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.234"}],"container-title":["Substance Abuse"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1080\/08897077.2017.1303423","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1080\/08897077.2017.1303423","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1080\/08897077.2017.1303423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T08:48:31Z","timestamp":1777625311000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1080\/08897077.2017.1303423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,4]]}},"alternative-id":["10.1080\/08897077.2017.1303423"],"URL":"https:\/\/doi.org\/10.1080\/08897077.2017.1303423","relation":{},"ISSN":["0889-7077","1547-0164"],"issn-type":[{"value":"0889-7077","type":"print"},{"value":"1547-0164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4]]}}}