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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4089 — VHA Service Utilization Before and After Receipt of a Service Connected Disability Award for PTSD: Findings from a National Sample

Lead/Presenter: John McCarthy
All Authors: McCarthy JF (SMITREC, Office of Mental Health Operations) Sripada RK (Center for Clinical Management Research) Hannemann CM (SMITREC, Office of Mental Health Operations) Schnurr PP (National Center for PTSD) Marx BP (National Center for PTSD) Hoff RA (NEPEC, Office of Mental Health Operations) Pollack S (Mental Health Services)

Veterans who receive service connected disability awards for Posttraumatic Stress Disorder (PTSD) commonly experience high distress and disability. VHA is committed to meeting their needs. Little is known about mental health services utilization prior and subsequent to disability awards. To inform VHA initiatives, we identified patterns of VHA mental health services utilization before and after new or increased PTSD service connection ratings and correlates of utilization trajectories.

Using VHA and Veterans Benefits Administration data, we identified a 10% random sample of VHA enrolled Veterans with new or increased PTSD ratings between 6/1/2012-12/31/2014 who were alive for 12 months following rating date. We assessed receipt of outpatient mental health encounters in each of the 52 weeks prior to and following the rating date. Using latent trajectory analysis, we identified clusters of individuals with similar utilization patterns. We determined the appropriate number of trajectories and assigned individuals to trajectories based on membership probabilities. Multinomial logistic regression analyses assessed associations between trajectory membership and Veteran age, gender, period of service, distance from nearest VHA facility, Military Sexual Trauma (MST), service connection level, and rating change status (new or increased).

The best fitting model had five groups: "No Use" (37.0% of Veterans), "Low Use" (37.8%), "Increasing Use" (9.0%), "Decreasing Use" (11.5%), and "High Use" (4.7%). Adjusting for other covariates and as compared to the "No Use" group, Veterans in the other groups were more likely to have served in the Gulf War or the Peacetime Era, to live closer to a VHA facility, have greater service connection, positive MST screens, and have had an increase rather than a new rating.

The majority of Veterans had little use in the 12 months prior to and following rating dates. Only 11.5% fit the trajectory of decreasing use. Data do not suggest that Veterans discontinue services following new or increased PTSD ratings.

Low VHA mental health services use in this sample supports expansion of efforts to ensure access and treatment engagement for Veterans who are service connected for PTSD. Future work will identify subpopulations that may benefit from targeted outreach.