Same-Day Receipt of Integrated VA Primary Care-Mental Health Services Increases Odds of Subsequent Mental Health Visit
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.
- 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.
- 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.
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.