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2011 HSR&D National Meeting Abstract

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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)

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).

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.

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).

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.

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

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