Integration of Primary Care and Mental Health Improves both Mental and Medical Care Utilization for OEF/OIF Veterans
BACKGROUND:
The integration of mental health services into primary care provides an excellent opportunity to address both mental and medical health needs, as both may occur simultaneously among patients in primary care settings. Primary Care-Mental Health Integration (PC-MHI), a VA initiative, sought to improve access to mental health care in primary care settings by placing mental health providers within primary care clinics. However, to date, no study has examined whether the PC/MHI program is associated with the retention of OEF/OIF Veterans with complex medical and psychological needs within the VA healthcare system. This study examined the lag time between a Veteran's first PC-MHI visit and next mental/medical care visit, if any, and the relationship of PC-MHI with short-tem (subsequent year) and long-term (four years later) use of VA healthcare. Using VA administrative data, investigators identified 2,470 OEF/OIF Veterans that received care during FY06 at the South Texas Veterans Health Care System. Veterans were followed through FY09. In addition to primary outcomes, independent measures included: demographics, VA priority status, mental health diagnoses at baseline, comorbid conditions, psychiatry visits for medication management, and prior use of VA healthcare.
FINDINGS:
- There was a significant association between VA's Primary Care-Mental Health Integration program and OEF/OIF Veterans' receipt of short- or long-term mental or medical care. Of the 181 Veterans who participated in the PC-MHI program, 60% sought mental health care within one month after their initial encounter in PC-MHI, and 82% after one year, while 18% sought medical care within one month, and 74% within one year.
- The average length of time to a subsequent specialty mental health care visit after the Veterans' first PC-MHI encounter was about 5 months.
- The average length of time to a subsequent medical care visit after the first PC-MHI encounter was about 10 months.
- While PTSD was the primary condition associated with OEF/OIF Veterans remaining in VA care for mental health care, retention in long-term medical care was not associated with mental health disorders measured in this study (PTSD, substance use disorder, major depressive disorder, and anxiety/phobia).
LIMITATIONS:
- Investigators could not control for the number of deployments, known to be associated with worse PTSD symptoms.
- Investigators were unable to examine the development or reduction of PTSD symptoms.
AUTHOR/FUNDING INFORMATION:
Drs. Zeber and Copeland are part of the Central Texas Veterans Health Care System and the Center for Applied Health Research, Temple, TX. Dr. Tsan is with the VISN 17 Center of Excellence in Research on Returning War Veterans.
Tsan J, Zeber J, Stock E, Sun F, and Copeland L. Primary Care-Mental Health Integration and Treatment Retention among Iraq and Afghanistan War Veterans. Psychological Services April 30, 2012; E-pub ahead of print.
