Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4018 — Mental Health Status Influences Veterans' Trust and Ratings of Provider Communication and VA Quality

Lead/Presenter: Catherine Chanfreau-Coffinier, COIN - Los Angeles
All Authors: Chanfreau-Coffinier CC (VA Greater Los Angeles COIN) Gordon HS (Jesse Brown (Chicago) VAMC) Darling JE (VA Greater Los Angeles COIN) Canelo I (VA Greater Los Angeles COIN) Yano EM (VA Greater Los Angeles COIN)

Objectives:
Improving patient outcomes hinges not only on high technical quality of care but also on how well providers communicate and engender trust in their patients during clinical encounters. This is especially true among women Veterans (WVs) whose numerical minority and rates of military sexual trauma may complicate care delivery and the doctor-patient relationship. We examined how mental health status may play a role in WVs' trust and ratings of provider communication and VA quality of care.

Methods:
We enrolled a population-based random sample of 1,395 WV routine primary care (PC) users in 12 VA medical centers participating in a cluster randomized trial of evidence-based quality improvement for tailoring PC to meet WVs' needs. We used computer-assisted telephone interviewing and validated measures of provider communication and VA quality from VA's Consumer Assessment of Health Plans/Patient-Centered Medical Home (CAHPS/PCMH), a previously validated measure of provider trust, and brief screeners for anxiety disorder, posttraumatic stress disorder (PTSD) and depression. Multivariate analyses were adjusted for socio-demographics, VA-only vs. dual use, and physical health.

Results:
Overall, WV routine PC users had high positive-screen rates for anxiety, PTSD and depression (48% GAD-2 and/or PTSD, 27% depression, 25% both anxiety and depression). WVs who screened positive for more than one MH condition provided the lowest ratings of their PC provider communication (OR = 0.44; 95%CI (0.31-0.63)), trust (OR = 0.49; 95%CI(0.30-0.79)), and both overall VA quality and PC quality (OR = 0.60; 95%CI(0.39-0.92), OR = 0.47; 95%CI(0.33-0.67), respectively).

Implications:
Mental health status influences Veterans' trust and ratings of provider communication and VA quality. Poorer ratings of provider communication are highest among those patients screening positive for more than one MH condition.

Impacts:
Improving Veterans' trust in VA is a top VA priority, and this work points to the role of providers in contributing to this goal in day-to-day practice. That said, providers likely need evidence-based strategies for responding to Veterans' communication needs, while more research is needed to better understand the communication style and information content that Veterans with MH conditions prefer.