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2019 HSR&D/QUERI National Conference Abstract

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1045 — PC-MHI Effects on Treatment Continuation

Lead/Presenter: Lisa kearney,  VA Center for Integrated Healthcare
All Authors: Kearney LK (VA Center for Integrated Healthcare), Kearney LK (VA Center for Integrated Healthcare), , Cornwell BL (National PCMHI Evaluation Office), Wray LO(VA Center for Integrated Healthcare), Pomerantz A (Office of Mental Health and Suicide Prevention), Woodward E (VA Quality Enhancement Research Initiative) , Kirchner J (VA Quality Enhancement Research Initiative), McCarthy JF(National PCMHI Evaluation Office)

Objectives:
The My VA Access Initiative emphasizes enhancement of Primary Care-Mental Health Integration (PC-MHI) same-day access, which may improve treatment engagement. This includes engagement following subsequent initial specialty mental health (SMH) encounters. Recent PC-MHI may enhance SMH continuation, yet no studies have assessed whether same-day PC-MHI receipt is also associated with SMH continuation. Further, the impact of a recent PC-MHI encounter may differ by race/ethnicity. We examined the impact of recent PC-MHI on SMH continuation and, for individual with prior PC-MHI encounters, we assessed whether same-day PC-MHI was associated with SMH continuation.

Methods:
437,051 primary care patients had an initial SMH encounter (none in 12 months) in FY2016 (N = 437,051). Multivariable logistic regression assessed whether odds of a subsequent SMH encounter within three months were greater for patients with PC-MHI that day, 1 day-3 months prior, or 4-12 months prior. For those with an initial PC-MHI encounter (none in 2 years) in the year prior to the initial SMH encounter (n = 226,006), we assessed whether receipt of subsequent SMH within three months differed by receipt of same-day PC-MHI on the date of the initial PC-MHI encounter. Analyses considered differences by race/ethnicity.

Results:
Recent PC-MHI receipt was associated with greater SMH continuation (OR = 1.16 for those with PC-MHI that day, 95%CI = 1.09,1.24; OR = 1.67 for those with PC-MHI within 1 day-3 months, CI = 1.63,1.70). The effect of PC-MHI within 1 day-3 months prior was greater for non-Hispanic white patients than other patients (OR = 1.72, 95%CI = 1.68-1.77 vs. OR = 1.60, 95%CI = 1.53-1.65; p < 0.001). Analyses specific to patients with an initial PC-MHI encounter in the year prior to initial SMH indicated that receipt of same-day PC-MHI was associated with greater SMH continuation (OR = 1.13, 95%CI = 1.10,1.15). The effect of same-day PC-MHI was lower for non-Hispanic white patients than other patients (OR = 1.10, 95%CI = 1.07-1.13 vs. OR = 1.16, 95%CI = 1.12-1.20; p = 0.01).

Implications:
Recent PC-MHI and same-day PC-MHI were each associated with greater SMH treatment continuation. Effects differed by race/ethnicity.

Impacts:
Targeting strategies that increase treatment engagement are critical given concerns regarding early attrition from evidence-based treatments. Integrated care offers an opportunity to enhance mental health access, in both primary care and SMH settings.