2011 HSR&D National Meeting Abstract
3048 — Limited Adoption of Integrated Mental Health Services in Primary Care, Findings from a National Survey of VA Primary Care Directors.
Klap RS (VA HSR&D Center for the Study of Healthcare Provider Behavior), Stockdale SE
(VA HSR&D Center for the Study of Healthcare Provider Behavior), Danielle RE
(VA HSR&D Center for the Study of Healthcare Provider Behavior), Ismelda I
(VA HSR&D Center for the Study of Healthcare Provider Behavior), Yano EM
(VA HSR&D Center for the Study of Healthcare Provider Behavior)
Community Based Outpatient Clinics (CBOCs) play a critical role in improving
Veterans’ access to care, particularly in rural areas. There are
concerns that CBOCs may not offer the same quality of care at VA
Medical Centers. Here we look at the availability of integrated
mental health care /primary care models at Community Based Outpatient
Clinics compared to VA Medical Centers (VAMCs).
We queried primary care (PC) directors from a census of VAMCs and
CBOCs serving 20,000+ PC patients in FY2006 (n = 225, 90% response
rate). Excluding sites with no mental health clinics (n = 4), we
created an analytic sample of 135 (62%) PC programs at VAMCs and 81
CBOCs (38%). We asked primary care directors if the following models
existed at their site: co-located collaborative mental health (i.e.,
MH provider in PC); TIDES model of primary care/ mental health care
management; Behavioral Health Laboratory; mental health provider in
primary care, and; health psychology. Response options included:
fully or partially implemented, planned or neither planned nor
implemented. We compared responses of VAMCs and CBOCs using Fisher’s
Compared to VAMCs, CBOCs were more likely to report full
implementation of co-located collaborative mental health care (39% of
CBOCs v. 21% of VAMCs), but they were also more likely to report that
this model was neither planned nor implemented (30% of CBOCs v. 20% of
VAMCs)(p < 0.01). For mental health primary care, CBOCs were less
likely to report full implementation (11% of CBOCs v. 20% of VAMCs),
and more likely to report that the models was neither planned not
implemented (82% of CBOCs v. 50% of VAMCs)(p < 0.001).
Two of the five integrated mental health/primary care models in VA
were less likely to be either planned or implemented at CBOCs,
compared to VAMCs.
Future research should identify barriers and facilitators to adoption
of integrated mental health /primary care among CBOCs.