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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3059 — Correlates of VA PTSD Specialty Treatment Utilization among Veterans Newly Diagnosed with PTSD

Lu MW (Mental Health & Neurosciences Division, Portland VA Medical Center), Duckart JP (Health Services Research and Development Service Research Enhancement Award Program, Portland VA Medical Center), O'Malley JP (Oregon Health and Science University, Oregon Clinical and Translational Research Institute), Dobscha SK (Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center)

Objectives:
Little is known about the extent to which U.S. veterans newly diagnosed with posttraumatic stress disorder (PTSD) receive PTSD specialty treatment, or about patient characteristics associated with receipt of PTSD specialty care. The main objective of this study was to identify predictors of receiving minimally adequate PTSD specialty treatment in the Department of Veterans Affairs (VA) healthcare system. A secondary objective was to determine if there were differences in predictors when comparing Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans to non-OEF/OIF veterans.

Methods:
VA administrative data were obtained for 869 veterans who had positive PTSD screens between 11/7/06 and 9/30/08, new PTSD diagnoses, and who attended an initial visit in a PTSD specialty clinic at four Northwest VA facilities. Logistic regression was used to model correlates of receiving minimally adequate specialty treatment (MAST), defined as nine or more visits to a PTSD specialty clinic in the year following the positive PTSD screen.

Results:
Two hundred eighty-six veterans (32.9%) completed MAST, or at least nine visits. Ninety-one veterans (10.5%) completed more than twenty visits. OEF/OIF veterans were less likely to complete MAST (29% vs. 36%, p = .021), and attended fewer visits (mean 8.2 vs. 9.9, p = .045) than non-OEF/OIF veterans. In both cohorts, predictors of receiving MAST included receiving an initial PTSD clinic visit within 30 days of a positive PTSD screen, living in an urban (versus rural) location, comorbid depression, and comorbid anxiety disorders. Alcohol use disorders predicted receipt of minimally adequate specialty treatment by OEF/OIF veterans, but not non-OEF/OIF veterans.

Implications:
The majority of veterans newly diagnosed with PTSD who initiate VA PTSD specialty care do not complete minimally adequate specialty treatment (MAST). On the other hand, a substantial minority receive more intensive treatment (more than twenty sessions during the year after screening). Further examination of factors contributing to premature treatment discontinuation or unusually high utilization is warranted. More rapid access to PTSD specialty care, and more convenient access for rural veterans, may increase participation in treatment.

Impacts:
This is the first study, to our knowledge, to examine predictors of receipt of minimally adequate treatment in VA PTSD specialty clinics.


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