Majority of OEF/OIF Veterans with PTSD Use VA Healthcare for PTSD-Related Treatment, and Users are Increasing
Public policy concerns regarding Veterans returning from OEF/OIF with PTSD are high. Addressing these policy issues will require, as first steps, estimating the number of Veterans with PTSD, as well as the proportion who already seek services. This study sought to estimate the percentage of OEF/OIF Veterans with PTSD who access VA healthcare, based on the concept of coverage — the proportion of patients that could benefit and actually receives the service. To estimate PTSD treatment needs, investigators reviewed relevant literature on the prevalence of PTSD among OEF/OIF Veterans, and then, using VA administrative data, multiplied the expected prevalence by the number of VA-eligible OEF/OIF Veterans. After estimating access to care, investigators reviewed the literature from national studies of VA healthcare utilization among OEF/OIF Veterans with PTSD through 12/31/10 to characterize the VA care Veterans with PTSD had received.
- Approximately 58% of OEF/OIF Veterans with PTSD used VA healthcare services and received some PTSD-related treatment from 2002 through 2010. Moreover, OEF/OIF Veterans with PTSD have been increasingly likely to use VA services over time.
- There is insufficient information about the quality of PTSD-related services. Developing a broader understanding of the concept of quality as it relates to PTSD treatment may lead to a better understanding of the services that OEF/OIF Veterans with PTSD receive when they access VA care.
- This analysis may present an inaccurate estimate of need, because estimates were based on PTSD Checklist (PCL) screening (a 17-item self-report measure). The sensitivity and specificity of this instrument in identifying PTSD has produced both false positives and false negatives. The exact effect of the use of the PCL in either under- or over-estimating the number of VA-eligible OEF/OIF Veterans with PTSD is unclear.
- This analysis may present an inaccurate estimate of utilization, because estimates were based on VA administrative data rather than structured clinical interviews. However, estimates of utilization were adjusted based on the known positive predicitive value of a clinical diagnosis of PTSD vis-Ã -vis screening with the PCL.
This work was supported by a VA-New England Early Career Development Award to Dr. Shiner. Drs. Shiner and Watts are from the White River Junction VAMC, White River Junction, VT. Dr. Desai is from the VA Northeast Program Evaluation Center, and Dr. Schnurr is from the VA National Center for PTSD Executive Division, White River Junction.
Shiner B, Drake R, Watts B, Desai R, and Schnurr P. Access to VA Services for Returning Veterans with PTSD. Military Medicine July 2012;177(7):814-822.