2006 HSR&D National Meeting Abstract
1023 — VA Post-Deployment Screening and Treatment Referral of OEF/OIF Veterans
Seal KH (San Francisco VA Medical Center)
Miner CR (San Francisco VA Medical Center)
Chu A (San Francisco VA Medical Center)
Bertenthal D (San Francisco VA Medical Center)
Among veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), we sought to determine the frequency of: 1) positive screens for mental health disorders, 2) mental health treatment acceptance, and 3) initial appointments kept.
In June 2004, the VA “Afghan and Iraq Post-Deployment Screen” was instituted as a mandated electronic clinical reminder. The screen consisted of brief, validated screening measures: 4-items for PTSD, 2-items for depression and the AUDIT-C for high-risk drinking. At the San Francisco VA Medical Center (SFVAMC), veterans screening positive for one or more disorders were offered a referral for mental health treatment. Among OEF/OIF veterans presenting to SFVAMC between June 2004 -October 2005, we analyzed the frequency of positive screens and, in an intention-to-treat analysis, we determined the frequency of mental health treatment referrals accepted and initial appointments kept.
554 OEF/OIF veterans were seen at SFVAMC, and of these, 176 (32%) underwent post-deployment screening. Of those screened, 90% were male; median age was 26 years. Positive screens for PTSD were found in 79 veterans (45%); 52 (30%) screened positive for depression and 56 (32%) screened positive for high-risk drinking. Of 56 OEF/OIF veterans screening positive for high-risk drinking, 55% reported >= 3 drinks/day and 71% reported drinking >= 6 drinks/occasion; 8/56 (14%) accepted a treatment referral, which resulted in only one scheduled clinic appointment, which was kept. Of 79 veterans screening positive for PTSD, 44/79 (56%) accepted a referral for mental health treatment which resulted in 32/79 (41%) scheduled clinic appointments, of which 28/79 (35%) were kept.
While only a minority of OEF/OIF veterans have been screened, a high proportion screened positive for combat-related mental health disorders. A smaller proportion accepted a treatment referral, yet not all received a scheduled clinic appointment, resulting in less than half of veterans with positive screens receiving mental health treatment.
Techniques such as motivational interviewing may enhance acceptance of mental health treatment referrals among veterans screening positive for combat-related mental health disorders. Moreover, once a mental health treatment referral is accepted, system improvements are needed to ensure that a clinic appointment is scheduled.