2012 HSR&D/QUERI National Conference Abstract
1033 — Return Visits Following Initial VHA Use by Patients with Mental Illnesses: Differences by Receipt of Primary Care - Mental Health Integration Services
Bohnert KM, Pfeiffer P, Szymanski B, and McCarthy JF, SMITREC/HSR&D VA Ann Arbor;
VHA implementation of Primary Care-Mental Health Integration (PC-MHI) is ongoing. PC-MHI services are designed to enhance mental health access and reduce stigma for Veterans receiving care in primary care (PC) settings. One outcome of receipt of PC-MHI may be greater likelihood that individuals with identified mental health needs will return for subsequent VHA services. In this study, we identified a cohort of new VHA users whose initial VHA care occurred in primary care (PC) settings and were diagnosed with a mental health disorder on that first visit, and we estimated the impact of PC-MHI services receipt on the likelihood of receiving a subsequent visit with PC, PC-MHI, or specialty mental health (SMH) encounters within 90 days.
Using National Patient Care Database records for a 30% random sample of PC patients in fiscal year 2009 (FY09), we identified a cohort of patients who: 1) received VA care for the first time in FY09, with no use in the prior 5 years; 2) had a PC encounter on the day of their initial VHA use; and 3) received a mental health diagnosis that day (n = 14,513). Using logistic regression, we assessed the association between PC-MHI receipt and the odds of receiving PC, PC-MHI, or SMH within 90 days of the initial visit. Analyses adjusted for sociodemographic characteristics, mental health diagnoses, and Charlson comorbidity based on diagnoses in the initial PC visit, and receipt of psychotropic medications on that date.
Seven percent (n = 1,053) of patients received PC-MHI services on the date of their initial encounter. Of these, 86% had a subsequent encounter within the next 90 days, as compared to 67% of those who did not receive PC-MHI. Initial PC-MHI receipt was associated with greater likelihood of having a subsequent encounter (Adjusted Odds Ratio = 2.2; 95% Confidence Interval = 1.9, 2.7).
Among individuals with an initial VHA encounter with a mental health diagnosis, PC-MHI services receipt on that date was associated with a more than two-fold greater odds of receiving a VHA encounter in the next 90 days.
PC-MHI services may enhance VHA retention in care among recipients with mental illnesses.