CNSPulse
W113

CLOSING THE CARE GAP: EMBEDDING PTSD SCREENING IN PRIMARY CARE WORKFLOWS

Allison Mandell — Kristen N. Benson2, Morgan Smith1, Jack Meullenet3, Bradley Goodnight3, Bharath Ravichandran3, Jonathan Xue3, Soma S. Nag4, Ahmad Abdrabboh4, Ferhat Ardic5, Brandon M. Kitay1 1Emory University School of Medicine, 2Tulane University, 3Guidehouse Inc., 4Otsuka Pharmaceutical Development and Commercialization, Inc, 5H. Lundbeck A/S

2026 ASCP Annual Meeting

Effective treatments for post-traumatic stress disorder (PTSD) exist, yet underdiagnosis and barriers to care persist, driving functional impairment and economic burden. Primary care offers a key setting to improve detection and access, though staffing limitations, time pressure, and competing priorities hinder implementation of screening workflows. We present preliminary findings from integrating the Primary Care PTSD Screen for DSM-5 (PCPTSD-5) into a primary care clinic and examining provider perspectives on factors that shape sustainable adoption. The PC-PTSD-5 was integrated into the electronic health record (EHR) and routine workflow of a primary care clinic. Screening was triggered for patients with Patient Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder-7 (GAD-7) scores ≥10. A midpoint evaluation used a mixed-methods approach: (1) quantitative monitoring of screening rates, positive-screen yield, diagnostic coding, and referrals; and (2) qualitative analysis using provider surveys and interviews structured by the Consolidated Framework for Implementation Research (CFIR). Large language models were used to accelerate and standardize qualitative coding. Preliminary analyses indicated that screening represented approximately 10% of monthly encounters (140 patients), with 23 patients per month meeting the positive-screen threshold. Among those screened, 22% scored ≥3 and 16% scored 4+. To date, 97 new PTSD problem list entries have been added, and 31 referrals have been initiated, with an average wait time of 2.4 months. The conversion rate from positive screen to diagnosis averaged roughly 60%, underscoring a diagnostic gap. CFIR interviews identified several themes, including primary care as a critical access point for discussing PTSD and mental health, limited referral capacity and resource constraints, time pressures, stigma surrounding PTSD and mental health, and opportunities to improve workflow and training. Targeted PC-PTSD-5 screening in primary care reliably identifies patients with probable PTSD, but it does not proportionally increase confirmed diagnoses. These findings highlight the need to pair screening with provider-informed workflow redesign to support adoption and long-term sustainability in primary care practice.