Study Suggests Initial Implementation of VA Primary Care Mental Health Not Associated with Differences in Specialty Mental Health Clinic Use by Veterans
VA is implementing system-wide primary care mental health services. Primary care mental health within VA employs a blended model of co-located, collaborative mental health specialists and care managers to improve screening and management of common mental health conditions (e.g., depression, alcohol misuse, and PTSD). By enhancing primary care-based treatment of common mental health conditions, an over-arching goal also is to increase access to specialty mental health clinics for Veterans with more severe or complex mental illnesses (e.g., bipolar disorder, schizophrenia). This study sought to determine whether the implementation of primary care mental health services is associated with differences in specialty mental health clinic use within the VA healthcare system. Investigators compared 118 VA facilities with primary care mental health to 142 VA facilities without this service on new mental health clinic use and diagnosis patterns among 49,957 Veterans between 4/08 and 3/09.
Findings show that the initial implementation of primary care mental health within VA is not associated with substantial differences in mental health clinic use – or diagnoses received in specialty mental health clinics by primary care patients. Facilities with primary care mental health – compared to those without – had similar rates of primary care patients initiating specialty mental health treatment (5.6% vs. 5.8%), and their primary care patients averaged similar total specialty mental health clinic visits (7.0 vs. 6.3). After adjusting for facility characteristics and multiple comparisons, there were no statistically significant differences with regard to diagnoses for Veterans who initiated specialty mental health clinic treatment at primary care mental health facilities.
The authors note that primary care mental health may impact mental health clinic use over longer periods of time as these programs mature.
Pfeiffer P, Szymanski B, Zivin K, et al. Are primary care mental health services associated with differences in specialty mental health clinic use? Psychiatric Services April 2011;62(4):422-25.
This study was partly funded by HSR&D. All authors are part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.