Module B: Management of ASD/PTSD in Primary Care

 
Patient presents to primary care with symptoms of PTSD (positive screening or previously diagnosed PTSD) [A] Assess risk of harm to self or others. Seek collateral information about stressors, service member's function, medical history, and absence or impairment on operation or mission [B] Assessment: History: psychiatric, medical, military, marital, family, past physical or sexual abuse, medication or substance use, social and spiritual life. Identify trauma history and duration. Obtain drug inventory (including over-the-counter drugs and
Assess dangerousness to self/others based on observation [C]
Assess environment for ongoing threats and protect from further harm [C]
Is patient dangerous to self or others or in danger or medically unstable? Provide appropriate care or refer to stabilize. Follow legal mandates
Obtain medical history and observation, physical examination, MSE, psychosocial assessment and appropriate lab tests (see side bar) . Assess function and fitness for duty. Asses risk factors [D]
Obtain medical history and observation, physical examination, MSE, psychosocial assessment and appropriate lab tests (see side bar) . Assess function and fitness for duty. Asses risk factors [E]
Obtain medical history and observation, physical examination, MSE, psychosocial assessment and appropriate lab tests (see side bar) . Assess function and fitness for duty. Asses risk factors [F]
Are there clinically significant symptoms suggestive of PTSD or ASD? [G] Summarize problems and discuss treatment options with patient/family [H] Primary care clinicians may decide to refer for specialized psychiatric care at any point, depending on how comfortable they are in treating PTSD, the particular needs and preferences of the patient, and the availability of other services
Box 7 no to box 14 Any coexisting sever/unstable mental conditions or severe or unstable PTSD? [I] Any coexisting sever/unstable mental conditions or severe or unstable PTSD? [J]
Arrive at shared decision regarding goals, expectations, and treatment options
Does provider or patient prefer referral to MH specialty? [K]
Follow-up as indicated. Screen annually for PTSD Consider consultation with mental health, treat specific symptoms of PTSD [L] Offer referral to Mental Health specialty. Coordinate patient care [K]
Collaborate with health members of team (RCS, Chaplain) [M]
Address fitness for duty (DoD) [N]