Same-Day Receipt of Integrated VA Primary Care-Mental Health Services Increases Odds of Subsequent Mental Health Visit
BACKGROUND:
VA is implementing integrated mental healthcare in primary care (PC) settings to improve the identification and management of common mental health conditions including depression, alcohol use problems, and PTSD. VAMCs and community-based outreach clinics (CBOCs) are mandated to have Primary Care-Mental Health Integration (PC-MHI) services, to enhance access and continuity of mental health care. This study evaluated whether same-day receipt of PC-MHI services was associated with the likelihood of receiving a mental health encounter in the following 90 days. Using FY09 VA data, investigators identified 9,046 Veterans who were new users of VA healthcare, initiated care in PC at a facility that provided PC-MHI services, and received a mental health diagnosis in PC on their first visit. The primary outcome was timely receipt of a subsequent encounter for a mental health condition, which was defined as a PC, PC-MHI, or specialty mental health encounter with a recorded mental health diagnosis within 90 days of the index visit. The main predictor of interest was receipt of PC-MHI services on the day of the initial encounter. Analyses adjusted for OEF/OIF Veteran status, demographics, service-connected disability, psychiatric and non-psychiatric diagnoses, and psychotropic medication initiation on the index day of service use.
FINDINGS:
- Of the 9,046 Veterans in this study, 635 (7%) received same-day PC-MHI services. Veterans who received same-day PC-MHI services had more than twice the odds of receiving a subsequent mental health encounter within 90 days compared with Veterans who did not receive same-day PC-MHI services, after adjustment for other covariates.
- Overall, 4,298 (48%) of the 9,046 Veterans in this study had a subsequent visit for a mental health condition within 90 days of their initial visit. Among those with same-day PC-MHI, 74% had a follow-up, as compared to 45% who did not receive same-day services.
- OEF/OIF Veterans had greater odds of a 90-day return visit compared with non-OEF/OIF Veterans. Also, Veterans in the two younger age groups (18-44 yrs and 45-64 yrs) had greater odds of a return visit than Veterans in the oldest age group (65+yrs).
- Each of the mental health disorders, with the exception of alcohol use disorder, was positively associated with a 90-day return visit, while Veterans with a physical comorbidity were less likely to return in the following 90 days.
LIMITATIONS:
- Although investigators adjusted for confounding variables, it is possible that an unmeasured variable (e.g., willingess to receive mental healthcare) influenced receipt of PC-MHI.
AUTHOR/FUNDING INFORMATION:
This study was conducted as part of the VA PC-MHI Evaluation. It was partly supported by HSR&D. All authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) and with HSR&D's Center for Clinical Management Research, Ann Arbor, MI.
Bohnert K, Pfeiffer P, Szymanski B, and McCarthy JF. Continuation of Mental Health Care Following an Initial Primary Care Visit with a Mental Health Diagnosis in VHA: Differences by Receipt of Primary Care-Mental Health Integration Services. General Hospital Psychiatry January 2013;35(1):66-70.
