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Study Suggests VA Geriatric Patient Aligned Care Teams Need Additional Mental Health Integration for Older Veterans


BACKGROUND:
VA is advanced compared to the U.S. private sector in providing a patient-centered medical home model to all Veterans and in its efforts to elaborate these models for specific populations. For example, Geriatric Patient Aligned Care Teams (GeriPACT) provide healthcare for a subset of older Veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges. VA is also advanced in its integration of mental healthcare into primary care, which is particularly relevant for older populations whose mental health needs are often under-recognized. This study examines mental healthcare integration within GeriPACT by describing the role of psychiatrists/psychologists to help inform geriatric mental health policy. Online surveys were completed in July 2016 by 101 GeriPACT teams that provided care to 32,408 Veterans at 44 VA sites. In addition, interviews were conducted between October 2016 and February 2017 with 24 medical providers (MDs and NPs).

FINDINGS:

  • Mental health integration was less than 50% in the GeriPACT teams in this study: only 43% of GeriPACT teams had a mental health provider – either a psychiatrist (29%) and/or psychologist (24%).
  • Teams with psychiatrist/psychologist providers were more likely to endorse management of psychosocial issues, dementia, and depression, indicating the potential benefit of including mental healthcare providers on teams.
    • For teams with psychiatrist/psychologist providers, respondents most frequently reported expertise in dementia (81%) and least frequently in depression (65%).
  • The structural characteristics of psychiatrist/psychologist integration varied widely.
    • Across 101 sites, 16% had both a psychiatrist and psychologist, 13% had a psychiatrist only, and 14% had a psychologist only.

IMPLICATIONS:

  • Further investigation of models of integrated mental healthcare in geriatric primary care represents a fertile area for geriatric mental health policy development.

LIMITATIONS:

  • This study only looked at mental health providers identified as a psychiatrist or psychologist, and not at other mental health professionals (i.e., psychiatric clinical nurse or clinical social worker).
  • This study was designed to look at general characteristics of GeriPACT and not specifically to examine mental healthcare, and site visits were conducted with a small number of high-adherence programs that do not represent all programs.

AUTHOR/FUNDING INFORMATION:
This study was funded through VA HSR&D's Quality Enhancement Research Initiative (QUERI). Dr. Sullivan and Ms. Adjognon are part of HSR&D's Center for Healthcare Organization and Implementation Research. Dr. Sullivan also is the principal investigator of the GeriPACT QUERI National Partnered Evaluation. Dr. Moye is part of the New England Geriatric Research, Education, and Clinical Center (GRECC).


Moye J, Harris G, Kube E, Hicken B, Adjognon O, Shay K, and Sullivan J. Mental Health Integration in Geriatric Patient Aligned Care Teams in the Department of Veterans Affairs. American Journal of Geriatric Psychiatry. September 13, 2018; epub ahead of print.

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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.