Assessing Healthcare Utilization among Veterans with Depression
A significant proportion of Veterans using VA healthcare also use non-VA healthcare. The effects of dual use on continuity and coordination of care for Veterans with chronic conditions that require ongoing management and medication, such as depressive disorders, may be detrimental. This study assessed levels and types of non-VA services used by depressed VA primary care patients, as well as patient factors associated with the use of non-VA healthcare among 550 Veterans in 10 VA primary care clinics across five states. Telephone interviews were conducted between 6/03 and 6/04. Investigators collected data on a number of variables, including: demographics, dual use, depression symptoms, post-traumatic stress disorder (PTSD), alcohol consumption, comorbidities, and care satisfaction.
Findings show that nearly half (46.8%) of VA primary care patients with significant depressive symptoms also used non-VA care. Among dual users, 94.9% used both VA and non-VA care for physical health problems, but only 20.3% used both for emotional health problems. VA-only users were more likely to report being satisfied or very satisfied with physical healthcare services than dual users (74% vs. 65%). Dual users were more likely to use acute care services (ER or inpatient), especially for physical health problems. Compared to VA-only users, dual users were more likely to be older, white, and have other health insurance. Dual users also had a higher level of medical comorbidity, but a lower level of alcohol use. Lower levels of alcohol use and the presence of PTSD were associated with the use of non-VA outpatient care for emotional health services. Authors suggest that as soldiers return from Iraq and Afghanistan, we may see an increase in Veterans with depression and PTSD seeking care in both VA and non-VA settings. Thus, they also suggest that care management strategies for Veterans with depression should include communication and coordination with non-VA providers.
Liu C, Bolkan C, Chan D, Yano E, Rubenstein L, and Chaney E. Dual use of VA and non-VA services among primary care patients with depression. Journal of General Internal Medicine March 2009;24(3):305-311.
This study was funded by HSR&D. Drs. Liu, Bolkan, and Chaney are part of HSR&D's Northwest Center for Outcomes Research in Older Adults; Drs. Yano and Rubenstein are part of HSR&D's Center for the Study of Healthcare Provider Behavior.