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2019 HSR&D/QUERI National Conference Abstract

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4026 — Same-Day Primary Care-Mental Health Integration Services: Propensity Scoring Analysis of Service Receipt and Treatment Initiation

Lead/Presenter: Brittany Cornwell,  Serious Mental Illness Treatment Resource and Evaluation Center
All Authors: Cornwell BL (OMHSP Serious Mental Illness Treatment Resource and Evaluation Center), Szymanski BR (OMHSP Serious Mental Illness Treatment Resource and Evaluation Center), Bohnert KM (OMHSP Serious Mental Illness Treatment Resource and Evaluation Center) McCarthy JF (OMHSP Serious Mental Illness Treatment Resource and Evaluation Center)

Objectives:
A high-profile measure of VHA mental health access is the availability of same-day Primary Care-Mental Health Integration (PC-MHI) services. PC-MHI was implemented in 2007 to improve access and facilitate treatment initiation. Analyses reported for fiscal year 2010 (FY2010) documented that primary care patients with positive depression screens who received same-day PC-MHI had greater depression treatment initiation. However, those analyses did not adjust for patient differences in propensity to receive same-day care, and the delivery of same-day PC-MHI care has since substantially expanded. We re-evaluated the impact of same-day PC-MHI services, comparing results with and without adjustment for patient propensity to have received same-day PC-MHI.

Methods:
Using data from the Corporate Data Warehouse, we identified 91,409 VHA patients with positive depression screens in Primary Care (PC) in FY2017, excluding those with a positive depression screen, depression diagnosis, or depression treatment in the prior year. We classified individuals by their receipt of PC-MHI and/or Specialty Mental Health (SMH) services in addition to PC. Using multivariable logistic regression, we assessed the odds of initiating psychotherapy and antidepressant medication treatment within 12 weeks, adjusting for demographic, diagnosis, and utilization measures. Using these measures, we created propensity score weights for the odds of same-day PC-MHI and/or SMH services and fit a weighted regression model.

Results:
With propensity score adjustment, same-day PC-MHI was associated with greater odds of initiating psychotherapy (OR: 9.66; 95% CI: 9.02-10.34) and antidepressant treatment (OR: 2.49, 95% CI: 2.34-2.65) compared to PC only. Without propensity scoring adjustment, the results were quite similar. These findings were consistent with 2010 results (OR: 8.16; 95% CI: 6.54-10.17; and OR: 2.33, 95% CI: 2.10-2.58, respectively.)

Implications:
Same-day PC-MHI receipt was associated with greater depression treatment initiation after adjusting for propensity to receive same-day PC-MHI and/or SMH services. Results are consistent with 2010 findings. They document stability in the estimated effects of PC-MHI and support ongoing efforts to ensure PC-MHI availability for same-day access.

Impacts:
Targeting strategies that enhance same-day access to collaborative mental health care for patients with positive depression screens are important for improving treatment initiation and engagement in the VHA.