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Assessing Perceptions of Access to Healthcare among Veterans with Bipolar Disorder


Nearly 70% of overall treatment costs for patients with bipolar disorder – a chronic mental illness – are attributable to high rates of co-occurring general medical disorders (i.e., hypertension, alcohol abuse, diabetes). However, recent evidence suggests that patients with serious mental illnesses have substantial unmet medical needs or fail to obtain necessary procedures. This naturalistic cohort study examined self-reported access barriers to mental health and general medical care among Veterans with bipolar disorder, and then explored patient factors associated with these perceptions (i.e., homelessness). Investigators analyzed self-reported survey data from 435 Veterans who received care at one large urban VA mental health facility between 7/04 and 7/06.

Findings show that despite the fact that all Veterans were currently receiving VA treatment for bipolar disorder, 15%-20% experienced trouble obtaining different aspects of healthcare when needed. Compared with accessing psychiatric care, Veterans with bipolar disorder reported greater difficulty accessing general medical services. Veterans experiencing current bipolar symptoms more frequently avoided psychiatric care due to cost, and perceived greater problems accessing medical specialists. As with mental healthcare services, the dominant influences predicting limitations in obtaining needed general medical care included living alone, an inpatient stay, homelessness, and current bipolar symptoms. For example, homeless Veterans were three times more likely to report barriers to psychiatric hospitalization. However, older and minority Veterans generally encountered fewer problems accessing treatment. The authors suggest that current VA efforts to expand mental healthcare access should be coupled with efforts to ensure adequate access to medical services for Veterans with chronic mental illness.

PubMed Logo Zeber J, Copeland L, McCarthy J, Bauer M, and Kilbourne A. Perceived access to general medical and psychiatric care among Veterans with bipolar disorder. American Journal of Public Health April 2009;99(4):720-727.

This study was funded by HSR&D. Drs. Zeber and Copeland are part of HSR&D’s Veterans Evidence-Based Research Dissemination and Implementation Center in San Antonio. Drs. McCarthy and Kilbourne are with VA’s Serious Mental Illness Treatment Research and Evaluation Center, part of HSR&D’s Center for Clinical Management Research in Ann Arbor.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.