Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3080 — OEF/OIF Veterans with PTSD are High Utilizers of Non-Mental Health VA Services

Seal KH (SFVAMC and UCSF) , Bertenthal D (SFVAMC), Miner CR (SFVAMC), Sen S (SFVAMC and UCSF), Marmar C (SFVAMC and UCSF)

Objectives:
Veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) are eligible for two years of free military service-related health care through the VA which includes approximately 145 PTSD specialty clinics. We aimed to determine the burden of VA health services utilization among OEF/OIF veterans with a PTSD diagnosis compared to those with no mental health diagnoses.

Methods:
Veterans separated from OEF/OIF service and first seen at VA facilities between September 30, 2001 (US invasion of Afghanistan) and September 30,2005 were included. The VA OEF/OIF Roster and National Patient Care Database were used to extract mental health ICD-9 diagnostic codes, outpatient clinic stop codes, and in-patient admission data. Fisher’s exact tests and negative binomial regression were used to compare the proportion and frequency of VA health services utilization between OEF/OIF veterans with a PTSD diagnosis and no mental health diagnoses.

Results:
Of 103,788 OEF/OIF veterans seen at VA facilities, 25,658 (25%) received one or more mental health diagnoses. PTSD was the most prevalent mental health diagnosis received by 13,205 (13%) OEF/OIF veterans. Ninety percent of OEF/OIF veterans diagnosed with PTSD visited a mental health clinic at least once, but of these, the majority (58%) had < = 6 visits. Most veterans diagnosed with PTSD (64%) never had a VA PTSD specialty clinic visit, and of those who did, only 4% completed a recommended 12 sessions of therapy. In contrast, OEF/OIF veterans with PTSD were significantly more likely than OEF/OIF veterans with no mental health diagnoses to have had an inpatient admission (OR=7.6, 95% CI=7.0-8.3), an emergency room visit (OR=2.4, 95% CI=2.3-2.5), or a primary care visit (OR=7.7, 95% CI=7.3-8.1). Moreover, OEF/OIF veterans with PTSD were significantly more likely to have had a greater number of non-mental health VA outpatient and inpatient visits than veterans with no mental health diagnoses (incidence rate ratio=2.3, 95% CI=2.3-2.4).

Implications:
OEF/OIF veterans with PTSD are comparatively high-intensity users of VA services, although most do not receive an adequate course of treatment for PTSD.

Impacts:
Interventions to facilitate an adequate course of mental health specialty treatment for OEF/OIF veterans with PTSD may reduce chronic mental illness and decrease the burden on other VA services.