Clinic-Level Predictors of Psychotherapy Dosage in the Military Health System.

McLean CP, Fong C, Haddock CK, Cook J, Peterson AL, Riggs DS, Young-McCaughan S, Conforte AM, Flores A, Jinkerson J, Jones ZK, Kim HJ, Link JS, Nofziger D, Ringdahl EN, Woodworth C, McCullen J, Ho E, Rosen CS, TACTICS Research Group. Clinic-Level Predictors of Psychotherapy Dosage in the Military Health System. Psychiatric services (Washington, D.C.). 2024 Nov 5; appips20240180.

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Abstract:

OBJECTIVE: This study aimed to describe the demand for, supply of, and clinic processes associated with behavioral health care delivery in the Military Health System and to examine the clinic-level factors associated with receipt of a minimally adequate dosage of psychotherapy. METHODS: This retrospective study used administrative behavioral health data from eight military treatment facilities (N = 25,433 patients; N = 241,028 encounters) that were participating in a larger implementation study of evidence-based psychotherapy for posttraumatic stress disorder. Minimally adequate dosage of psychotherapy was defined in two ways: at least three sessions within a 90-day period and at least six sessions within a 90-day period. The authors then used a path model to examine clinic-level factors hypothesized to predict psychotherapy dosage, including care demand, supply, and processes. RESULTS: Patients had an average of 2.5 psychotherapy appointments per quarter. Wait times for intake, between intake and the first psychotherapy session, and between follow-up sessions all averaged 17 days or longer. Path modeling showed that a higher patient-to-encounter ratio was associated with a longer wait time between follow-up psychotherapy appointments. In turn, a longer wait time between appointments was associated with a lower probability of receiving an adequate dosage of psychotherapy. However, a greater proportion of care delivered in groups was associated with a greater probability of receiving at least six sessions of psychotherapy. CONCLUSIONS: Receipt of a minimally adequate dosage of psychotherapy in the Military Health System is hindered by clinic staffing and workflows that increase wait times between follow-up psychotherapy appointments.