Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4063 — Mental Health and Dual Use: Understanding Women Veterans' Care Coordination Needs

Lead/Presenter: Danielle Rose, COIN - Los Angeles
All Authors: Rose DE (CSHIIP) Brunner JB (CSHIIP) Darling J (USC) Canelo I (CSHIIP) Yano EM (CSHIIP)

Objectives:
Patient Aligned Care Teams (PACT), VA's patient-centered medical home model, was intended to improve Veterans' care coordination experiences. Care coordination is important for women Veterans (WVs) because of comparable physical health status, greater mental health burden and reliance on non-VA care. We examined the extent to which WVs' report that their care is coordinated by their primary care (PC) provider and team, and if there were differences by health status and dual (VA and non-VA) use of care.

Methods:
We conducted computer-assisted telephone interviews with 1,395 WVs with 3+ PC and/or women's health visits during the prior year at 12 VA medical centers. Interviews were conducted January-March 2015 (47% response rate). We measured care coordination by asking whether PC provider/team helped them manage care with other providers/services (all v. some/none). Self-reported patient information included socio-demographics, physical health status, at least one mental health (MH) visit in past year, and use of non-VA care. We performed two multivariate logistic regressions weighted for non-response and sampling design, to examine associations between care coordination and health status and MH use.

Results:
Two-thirds (66%) of WVs reported that all their care was managed by their PC provider/team. In adjusted analyses, WVs in fair/poor health were more likely to report good care coordination, (OR: 1.36, 95%CI: 1.09-1.70), while WVs with MH use were less likely (OR: .72, 95%CI: .61-.85). In both analyses, WVs using VA only were twice as likely to report good care coordination (OR (PH): 2.32, 95%CI: 1.72-3.13; OR (MH): 2.27, 95%CI: 1.71-3.03) compared to dual users.

Implications:
The majority of WVs reported that all their care was managed by their PC provider/team, an indication of good care coordination. While WVs with fair/poor health reported good care coordination, WVs with MH use and dual use were less likely to do so.

Impacts:
VA is expanding use of non-VA care. New systems may be needed to ensure that WVs using non-VA care experience the same coordinated care as those using only VA care. While PC-MH integration should facilitate care coordination for WVs, these programs may not be equally available in women's health compared to general PC clinics.