{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:14Z","timestamp":1787022074845,"version":"build-2736575974"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T00:00:00Z","timestamp":1609113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["RRP 13-440"],"award-info":[{"award-number":["RRP 13-440"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department of Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation of PTM are unknown. We conducted a study to: 1) estimate levels of PTM program implementation in VA Audiology and Mental Health clinics across the country; and 2) identify barriers and facilitators to PTM implementation based on the experiences of VA audiologists and mental health providers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted an anonymous, web-based survey targeting Audiology and Mental Health leaders at 144 major VA facilities. Quantitative analyses summarized respondents\u2019 facility characteristics and levels of program implementation (full PTM, partial PTM, or no PTM). Qualitative analyses identified themes in factors influencing the implementation of PTM across VA sites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Surveys from 87 audiologists and 66 mental health clinicians revealed that few facilities offered full PTM; the majority offered partial or no PTM. Inductive analysis of the open-ended survey responses identified seven factors influencing implementation of PTM: 1) available resources, 2) service collaboration, 3) prioritization, 4) Veterans\u2019 preferences and needs, 5) clinician training, 6) awareness of (evidence-based) options, and 7) perceptions of scope of practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Results suggest wide variation in services provided, a need for greater engagement of mental health providers in tinnitus care, and an interest among both audiologists and mental health providers in receiving tinnitus-related training. Future research should address barriers to PTM implementation, including methods to: 1) improve understanding among mental health providers of their potential role in tinnitus management; 2) enhance coordination of tinnitus-related care between health care disciplines; and 3) collect empirical data on Veterans\u2019 need for and interest in PTM, including delivery by telehealth modalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0242007","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T13:38:07Z","timestamp":1609162687000},"page":"e0242007","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Factors affecting the implementation of evidence-based Progressive Tinnitus Management in Department of Veterans Affairs Medical Centers"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3896-1416","authenticated-orcid":true,"given":"Tara L.","family":"Zaugg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J.","family":"Thielman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen F.","family":"Carlson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana\u00efs","family":"Tuepker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Elnitsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Drummond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline J.","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Summer","family":"Newell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Kaelin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christie","family":"Choma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Henry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,28]]},"reference":[{"issue":"8","key":"pone.0242007.ref001","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1097\/MAO.0000000000001070","article-title":"\"Measurement\" of Tinnitus","volume":"37","author":"JA Henry","year":"2016","journal-title":"Otol Neurotol"},{"key":"pone.0242007.ref002","first-page":"1","volume-title":"Tinnitus Handbook","author":"A Davis","year":"2000"},{"issue":"5","key":"pone.0242007.ref003","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1044\/2016_JSLHR-H-16-0126","article-title":"Randomized controlled trial in clinical settings to evaluate effectiveness of coping skills education used with Progressive Tinnitus Management","volume":"60","author":"JA Henry","year":"2017","journal-title":"J Speech Lang Hear Res"},{"key":"pone.0242007.ref004","article-title":"Retrospective assessment of the efficacy of modified Progressive Tinnitus Management skills education in a military medical treatment facility","author":"LP Sherlock","year":"2019","journal-title":"Mil Med"},{"issue":"42","key":"pone.0242007.ref005","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/1463-1741.45311","article-title":"Principles and application of counseling used in Progressive Audiologic Tinnitus Management","volume":"11","author":"JA Henry","year":"2009","journal-title":"Noise Health"},{"issue":"4","key":"pone.0242007.ref006","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1682\/JRRD.2013.08.0189","article-title":"Development of a progressive audiologic tinnitus management program for Veterans with tinnitus","volume":"51","author":"PJ Myers","year":"2014","journal-title":"J Rehab Res Devel"},{"issue":"1S","key":"pone.0242007.ref007","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1044\/2018_AJA-TTR17-18-0042","article-title":"Health care utilization and mental health diagnoses among veterans with tinnitus","volume":"28","author":"KF Carlson","year":"2019","journal-title":"Am J Audiol"},{"issue":"2 Suppl","key":"pone.0242007.ref008","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1177\/0194599814545325","article-title":"Clinical practice guideline: tinnitus","volume":"151","author":"DE Tunkel","year":"2014","journal-title":"Otolaryngol Head Neck Surg"},{"key":"pone.0242007.ref009","doi-asserted-by":"crossref","first-page":"206","DOI":"10.3389\/fpsyg.2017.00206","article-title":"Different teams, same conclusions? 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