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HSR&D 2004 National Meeting Abstracts


1024. Impact of Organizational Characteristics on Primary Care MH Services
JoAnn E Kirchner, MD, VA South Central Mental Illness, Research, Education, and Clinical Center (MIRECC) and HSR&D Center fo Mental Healthcare & Outcomes Research (CeMHOR) at Central Arkansas Veterans Healhtcare System and University of Arkansas for Medical Sciences, RR Owen, VA South Central Mental Illness, Research, Education, and Clinical Center (MIRECC) and HSR&D Center fo Mental Healthcare & Outcomes Research (CeMHOR) at Central Arkansas Veterans Healhtcare System and University of Arkansas for Medical Sciences, K Henderson, VA South Central Mental Illness, Research, Education, and Clinical Center (MIRECC), N Dockter, University of Arkansas for Medical Sciences, T Armitage, VA South Central Mental Illness, Research, Education, and Clinical Center (MIRECC) and HSR&D Center fo Mental Healthcare & Outcomes Research (CeMHOR) at Central Arkansas Veterans Healhtcare System and University of Arkansas for Medical Sciences

Objectives: This study examined differences in structures and processes of mental health care (staffing, services, integration of mental health services, collaboration, prescribing patterns, service utilization, written suicide protocol, length of wait for referrals, and distance to specialty care) at VA primary care clinics, comparing VA Medical Center (VAMC) clinics to Community-Based Outpatient Clinics (CBOCs). Characteristics of CBOCs (rural vs. urban, large vs. small patient populations, VA staff-operated vs. contract staff-operated) were also compared.

Methods: Nurse managers at 46 of 49 PCCs (23 VAMC clinics and 23 CBOCs) in the South Central VA Health Care Network were surveyed. Results were linked to key processes of care derived from VA clinical databases.

Results: Integration of care and services overall were comparable between VAMC clinics and CBOCs. However, integrated CBOCs more often offered group therapy, medication management and smoking cessation than integrated VAMC clinics, and VAMC clinics more often provided routine depression screenings and more often had a written suicide protocol. Distance to offsite specialty care was greater for patients of CBOCs than VAMCs. Urban CBOCs and VA staff-operated CBOCs were more often integrated than rural CBOCs and contract staff-operated CBOCs, respecitively. Average waits for offsite urgent and routine referrals were significantly shorter at VAMCs than CBOCs. Results of data analysis linking survey findings to database process of care variables will be reported.

Conclusions: Provision of mental health care at CBOCs is comparable to that at VAMC clinics, although some differences indicate full equity has not been achieved.