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Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care-Mental Health Integration services.

Bohnert KM, Pfeiffer PN, Szymanski BR, McCarthy JF. Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care-Mental Health Integration services. General hospital psychiatry. 2013 Jan 1; 35(1):66-70.

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Abstract:

OBJECTIVE: For patients with an initial primary care (PC) encounter in the Veterans Health Administration (VHA) that included a mental health diagnosis, we evaluate whether same-day receipt of Primary Care-Mental Health Integration (PC-MHI) services is associated with the likelihood of receiving a subsequent mental-health-related encounter in the following 90 days. METHOD: Using VHA administrative data, we identified 9046 patients who received VHA care for the first time in fiscal year 2009, received a PC encounter that included a mental health diagnosis on the first day of their VHA services and initiated care at a VHA facility that provided PC-MHI services. Using multivariable generalized estimating equations logistic regression, we examined whether receipt of same-day PC-MHI was associated with receipt of a subsequent encounter with a mental health diagnosis within 90 days. Analyses adjusted for Operation Enduring Freedom/Operation Iraqi Freedom Veteran status, demographic characteristics, service-connected disability, psychiatric and non-psychiatric diagnoses, and psychotropic medication initiation on the index day of service use. RESULTS: Receipt of same-day PC-MHI services was positively associated with having a mental-health-related encounter in the following 90 days (adjusted odds ratio = 2.05; 95% confidence interval = 1.66-2.54). CONCLUSIONS: PC-MHI services may enhance mental health continuation of care among PC patients with mental health conditions who initiate VHA services.





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