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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3080 — Primary Care Mental Health Integration and Persistence in Care among Iraq and Afghanistan War Veterans

Tsan JY, Central Texas VA Healthcare System, Center of Excellence, & Center for Applied Health Research; Zeber JEStock EM, and Copeland LA, Central Texas VA Healthcare System, Center for Applied Health Research, & Scott and White Healthcare System;

Integration of mental health services into primary care provides an excellent opportunity to address both mental health and medical needs. Primary care mental health integration (PCMHI) was implemented in 2006 as one of several initiatives to improve health care delivery to OEF/OIF Veterans, yet to date no study has examined whether PCMHI is associated with persistence in care for OEF/OIF Veterans. As post-traumatic stress disorder (PTSD) is a complex, debilitating illness common among our new Veterans, incurring both mental and medical care needs, we analyzed VA utilization for these returning service personnel over a 4-year period to assess whether PCMHI or other types of mental health care were associated with persistence, defined as annual outpatient mental or medical care (4-year treatment retention).

We extracted data for 2,470 OEF/OIF Veterans (86% male, 41% racial/ethnic minority) receiving care in the South Texas Veterans healthcare system in FY2006. Logistic regression modeled persistence (yes/no) as a function of mental health care, controlling for socio-demographics and comorbidity.

Persistence was associated with PTSD (OR = 2.6), depression (OR = 2.8), substance use disorders (OR = 1.6), Priority 1 status (OR = 3.4), women (OR = 1.6), and age in decades (OR = 1.3). Whether patients received PCMHI versus predominantly individual or group psychotherapy during FY2006 was not associated with persistence in VA care through FY2009. Among those diagnosed with PTSD (n = 829), similar results obtained.

Results from this study suggest that OEF/OIF Veterans with PTSD, major depression, or substance use disorders are more strongly motivated to maintain contact with the VA system compared to their counterparts without those disorders. However, the type of mental health care received was not associated with persistence, perhaps implying that perceived need is more important and encourages longitudinal treatment retention. Research to evaluate the role of PCMHI in engaging Veterans into ongoing VA care should solicit patient input.

It will be important for the VA to assess need and determine what aspects of PCMHI and other innovative care approaches are associated with treatment retention and response in order to accommodate the myriad of treatment challenges for our growing cohort of OEF/OIF Veterans reliant upon VA care.

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