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2019 HSR&D/QUERI National Conference Abstract

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1173 — The Role of Patient Experience in Obtaining High Quality Mental Health Treatment Among Women Veterans

Lead/Presenter: Fernanda Rossi,  COIN - Palo Alto
All Authors: Rossi FS (Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine), Javier S (Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine), Kimerling R (Center for Innovation to Implementation, VA Palo Alto Health Care System)

Objectives:
Many veterans utilizing VHA mental health (MH) services do not receive adequate doses of treatment to achieve clinical benefit. The role of patient experience may be particularly important for women veterans. This study sought to examine associations of women's MH treatment experiences in obtaining a potentially therapeutic dose of MH care.

Methods:
We used a nationally representative sample of 2,480 women veterans in VHA primary care who completed the WOMAN survey, utilized VHA MH services, and reported a perceived need for MH treatment. Outpatient MH utilization over the past 18 months prior to survey was obtained from VA administrative data and grouped into episodes, defined by 90-day treatment free periods. We defined a potentially therapeutic dose of MH treatment as a) 8+ psychotherapy visits with the same provider; or b) 84+ days of continuous psychotropic medications and 2+ medication management visits. Patient experience variables queried: access to gender-sensitive care (female providers, women's clinic), ease of getting care, feeling out of place in MH settings due to gender, and ratings of how well MH treatment met women's needs.

Results:
Nearly half of women (46%) had only one MH treatment episode (range 1-8). The median number of days within a MH episode was 72 (interquartile range (IQR): 1-226.5 days). The median number of outpatient visits per MH episode was 3 (IQR: 1-11). Less than half (47.5%) of women had at least one episode in which they received a potentially therapeutic dose of MH treatment. Women who reported positive care experiences were at greater odds of obtaining a potentially therapeutic dose of MH treatment. Access to women's clinic was the only variable not associated with receiving a therapeutic dose of MH treatment.

Implications:
Despite over half of women not having received a potentially therapeutic dose of MH treatment, those who did were also more likely to have had positive MH care experiences. Thus, positive patient experience appears to be closely linked to receiving high quality MH care.

Impacts:
Attention to patient experience may be necessary for promoting high-value MH care, if improving patient experience can help more women veterans obtain clinically beneficial doses of MH treatment.