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Initiation of Primary Care-Mental Health Integration programs in the VA Health System: associations with psychiatric diagnoses in primary care.
Med Care. 2010 Sep; 48(9):843-51.MC

Abstract

BACKGROUND

Providing collaborative mental health treatment within primary care settings improves depression outcomes and may improve detection of mental disorders. Few studies have assessed the effect of collaborative mental health treatment programs on diagnosis of mental disorders in primary care populations. In 2008, many Department of Veterans Affairs (VA) facilities implemented collaborative care programs, as part of the VA's Primary Care-Mental Health Integration (PC-MHI) program.

OBJECTIVES

To assess the prevalence of diagnosed mental health conditions among primary care patient populations in association with PC-MHI programs, overall and for patient subpopulations that may be less likely to receive mental health treatment.

RESEARCH DESIGN

Using a difference-in-differences analysis, we evaluated whether the rates of psychiatric diagnoses among primary care patient populations at 294 VA facilities changed from fiscal year (FY)07 to FY08, and whether trends differed at facilities with PC-MHI encounters in FY08. Subgroup analyses examined whether trends differed by patient age and race/ethnicity. SUBJECTS, MEASURES, AND RESULTS: From FY07 to FY08, the prevalence of diagnosed depression, anxiety, post-traumatic stress disorder, and alcohol abuse increased more in the 137 facilities with PC-MHI program encounters than in the 157 facilities without these encounters. Increases were more likely among patients who were younger (18-64) and white.

CONCLUSIONS

Initiation of PC-MHI programs was associated with elevated diagnosis patterns, which may enhance recognition of mental health needs among primary care patients. Increases in diagnosis prevalence were not uniform across patient subgroups. Further research is needed on treatment processes and outcomes for individuals receiving services in PC-MHI programs.

Authors+Show Affiliations

Department of Veterans Affairs, National Serious Mental Illness Treatment Research and Evaluation Center and Health Services Research and Development (HSR&D) Center for Clinical Management Research, Ann Arbor, MI, USA. kzivin@umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

20706160

Citation

Zivin, Kara, et al. "Initiation of Primary Care-Mental Health Integration Programs in the VA Health System: Associations With Psychiatric Diagnoses in Primary Care." Medical Care, vol. 48, no. 9, 2010, pp. 843-51.
Zivin K, Pfeiffer PN, Szymanski BR, et al. Initiation of Primary Care-Mental Health Integration programs in the VA Health System: associations with psychiatric diagnoses in primary care. Med Care. 2010;48(9):843-51.
Zivin, K., Pfeiffer, P. N., Szymanski, B. R., Valenstein, M., Post, E. P., Miller, E. M., & McCarthy, J. F. (2010). Initiation of Primary Care-Mental Health Integration programs in the VA Health System: associations with psychiatric diagnoses in primary care. Medical Care, 48(9), 843-51. https://doi.org/10.1097/MLR.0b013e3181e5792b
Zivin K, et al. Initiation of Primary Care-Mental Health Integration Programs in the VA Health System: Associations With Psychiatric Diagnoses in Primary Care. Med Care. 2010;48(9):843-51. PubMed PMID: 20706160.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initiation of Primary Care-Mental Health Integration programs in the VA Health System: associations with psychiatric diagnoses in primary care. AU - Zivin,Kara, AU - Pfeiffer,Paul N, AU - Szymanski,Benjamin R, AU - Valenstein,Marcia, AU - Post,Edward P, AU - Miller,Erin M, AU - McCarthy,John F, PY - 2010/8/14/entrez PY - 2010/8/14/pubmed PY - 2010/9/14/medline SP - 843 EP - 51 JF - Medical care JO - Med Care VL - 48 IS - 9 N2 - BACKGROUND: Providing collaborative mental health treatment within primary care settings improves depression outcomes and may improve detection of mental disorders. Few studies have assessed the effect of collaborative mental health treatment programs on diagnosis of mental disorders in primary care populations. In 2008, many Department of Veterans Affairs (VA) facilities implemented collaborative care programs, as part of the VA's Primary Care-Mental Health Integration (PC-MHI) program. OBJECTIVES: To assess the prevalence of diagnosed mental health conditions among primary care patient populations in association with PC-MHI programs, overall and for patient subpopulations that may be less likely to receive mental health treatment. RESEARCH DESIGN: Using a difference-in-differences analysis, we evaluated whether the rates of psychiatric diagnoses among primary care patient populations at 294 VA facilities changed from fiscal year (FY)07 to FY08, and whether trends differed at facilities with PC-MHI encounters in FY08. Subgroup analyses examined whether trends differed by patient age and race/ethnicity. SUBJECTS, MEASURES, AND RESULTS: From FY07 to FY08, the prevalence of diagnosed depression, anxiety, post-traumatic stress disorder, and alcohol abuse increased more in the 137 facilities with PC-MHI program encounters than in the 157 facilities without these encounters. Increases were more likely among patients who were younger (18-64) and white. CONCLUSIONS: Initiation of PC-MHI programs was associated with elevated diagnosis patterns, which may enhance recognition of mental health needs among primary care patients. Increases in diagnosis prevalence were not uniform across patient subgroups. Further research is needed on treatment processes and outcomes for individuals receiving services in PC-MHI programs. SN - 1537-1948 UR - https://www.unboundmedicine.com/medline/citation/20706160/Initiation_of_Primary_Care_Mental_Health_Integration_programs_in_the_VA_Health_System:_associations_with_psychiatric_diagnoses_in_primary_care_ L2 - https://doi.org/10.1097/MLR.0b013e3181e5792b DB - PRIME DP - Unbound Medicine ER -