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Facility-level factors associated with guideline-concordant prazosin dosing for Veterans with posttraumatic stress disorder.

To the Editor: We found the article by Alexander and colleagues1 in the May 2015 issue of the Journal to be a compelling demonstration of the potential underdosing of prazosin for posttraumatic stress disorder (PTSD) in the Veterans Health Administration (VHA). The authors reported that only 14.1% of PTSD patients who were prescribed prazosin reached the minimum guideline-concordant dose of 6 mg/d.1 As they note, a greater understanding of the factors associated with underdosing may aid in identifying strategies to achieve guideline-concordant treatment. In addition to the individual patient characteristics reported by Alexander et al1 to be associated with prazosin dosing, the overall quality of PTSD care provided at a facility and other facilitylevel characteristics may also play a role in prazosin prescribing. As part of an ongoing study of PTSD-related sleep disorders, we assessed the association between prazosin dosing and facility-level characteristics, including quality indicators of PTSD psychotherapy and pharmacotherapy. We hypothesized that guideline-concordant prazosin administration would be positively associated with PTSD quality measures.