Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

2011 HSR&D National Meeting Abstract

Printable View

2011 National Meeting

1072 — Does Integrating Mental Health Services in VA Primary Care Reduce Barriers to Mental Health Care for OEF/OIF Veterans?

Seal KH (San Francisco VAMC), Cohen GH (San Francisco VAMC), Bertenthal D (San Francsico VAMC), Cohen BE (San Francisco VAMC), Maguen S (San Francisco VAMC)

Objectives:
Despite high rates of post-deployment mental health (MH) problems in OEF/OIF veterans, MH services are under-utilized. We evaluated whether, in a VA primary care clinic, an initial Integrated Care (IC) visit, consisting of co-located primary care and MH services, improved MH utilization in OEF/OIF veterans compared to Usual Care (UC).

Methods:
Between 4/1/2007 and 4/31/2009, 347 OEF/OIF veterans with no MH care within 60 days initiated primary care at an urban VA Medical Center. VA administrative and chart review data were used to generate descriptive statistics; multivariable models were used to compare the independent effects of an initial primary care IC versus UC visit on MH utilization.

Results:
Of 347 OEF/OIF veterans initiating VA primary care, 230 (66%) were seen in the IC clinic and 117 (34%) were seen in the UC clinic. Median age was 28 (IQR = 25-36); 11% were female and 41% were ethnic minorities. The majority (58%) screened positive for one or more MH problems. Eighty-nine percent of veterans in the IC clinic versus 51% in the UC clinic (p = < .001) had an MH evaluation on the same day as their initial primary care visit. Expanding the timeframe, 92% in IC versus 59% in UC (p = < .001) had an MH evaluation within 30 days of their initial primary care visit. Of veterans who had an initial MH evaluation, 44% in IC versus 43% in UC returned for a follow-up MH visit in an MH specialty clinic (p = NS). After adjusting for MH screen result and age, OEF/OIF veterans seen in IC were significantly more likely to receive MH care within 30 days of their initial primary care visit than those seen in UC [Relative Risk (RR) = 1.50; 95% CI = 1.29-1.75]. Women OEF/OIF veterans were over three times as likely to receive MH care within 30 days of primary care if seen in the IC versus UC clinic. (RR = 3.18, 95% CI = 1.5-6.70).

Implications:
Among OEF/OIF veterans, particularly women, an initial integrated primary care visit significantly increased early MH services utilization, but did not significantly impact utilization of follow-up MH care.

Impacts:
Extending integrated, co-located primary care and MH services beyond the initial visit may improve follow-up MH care in OEF/OIF veterans.


Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.