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Primary care-mental health integration and treatment retention among Iraq and Afghanistan war veterans.
Psychol Serv. 2012 Nov; 9(4):336-48.PS

Abstract

Despite the high prevalence of posttraumatic stress disorder (PTSD) and medical comorbidity among veterans from Iraq/Afghanistan (OEF/OIF), keeping these patients engaged in health care is challenging. Primary Care-Mental Health Integration (PC-MHI), an initiative in the Veterans Health Administration (VA), sought to improve access to mental health care from within primary care. This study examined the lag between first PC-MHI visit and next mental/medical care visit, if any, and the relationship of PC-MHI with short-term (subsequent year) and long-term (4 years later) use of VA. We identified 2,470 OEF/OIF veterans receiving care during fiscal year 2006 (FY06) in a regional VA health care system. Unconditional survival analysis modeled time to next mental/medical visit and logistic regression modeled short- and long-term care as a function of PC-MHI, demographics, and clinical covariates. Of 181 patients in the PC-MHI program, 60%/18% returned for mental/medical care within 1 month, and 82%/74% within 1 year. Sixty-one percent (1,503) were still using the VA in FY09. Short-term mental care was related to prior-year PC-MHI. Consistent correlates of short- and long-term mental/medical care included physical comorbidity and Priority 1 status. Most patients attended mental health appointments subsequent to PC-MHI, and PC-MHI was correlated with mental health treatment retention in adjusted models for our cohort. Need for treatment, notably VA Priority 1 status and physical comorbidity, were the primary correlates of care-seeking. Developing innovative approaches to engaging new veterans in care remains imperative as multiple options will be necessary to meet the needs of these complex patients.

Authors+Show Affiliations

Department of Veterans Affairs. Jack.Tsan@va.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22545824

Citation

Tsan, Jack Y., et al. "Primary Care-mental Health Integration and Treatment Retention Among Iraq and Afghanistan War Veterans." Psychological Services, vol. 9, no. 4, 2012, pp. 336-48.
Tsan JY, Zeber JE, Stock EM, et al. Primary care-mental health integration and treatment retention among Iraq and Afghanistan war veterans. Psychol Serv. 2012;9(4):336-48.
Tsan, J. Y., Zeber, J. E., Stock, E. M., Sun, F., & Copeland, L. A. (2012). Primary care-mental health integration and treatment retention among Iraq and Afghanistan war veterans. Psychological Services, 9(4), 336-48. https://doi.org/10.1037/a0028308
Tsan JY, et al. Primary Care-mental Health Integration and Treatment Retention Among Iraq and Afghanistan War Veterans. Psychol Serv. 2012;9(4):336-48. PubMed PMID: 22545824.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary care-mental health integration and treatment retention among Iraq and Afghanistan war veterans. AU - Tsan,Jack Y, AU - Zeber,John E, AU - Stock,Eileen M, AU - Sun,Fangfang, AU - Copeland,Laurel A, Y1 - 2012/04/30/ PY - 2012/5/2/entrez PY - 2012/5/2/pubmed PY - 2013/5/3/medline SP - 336 EP - 48 JF - Psychological services JO - Psychol Serv VL - 9 IS - 4 N2 - Despite the high prevalence of posttraumatic stress disorder (PTSD) and medical comorbidity among veterans from Iraq/Afghanistan (OEF/OIF), keeping these patients engaged in health care is challenging. Primary Care-Mental Health Integration (PC-MHI), an initiative in the Veterans Health Administration (VA), sought to improve access to mental health care from within primary care. This study examined the lag between first PC-MHI visit and next mental/medical care visit, if any, and the relationship of PC-MHI with short-term (subsequent year) and long-term (4 years later) use of VA. We identified 2,470 OEF/OIF veterans receiving care during fiscal year 2006 (FY06) in a regional VA health care system. Unconditional survival analysis modeled time to next mental/medical visit and logistic regression modeled short- and long-term care as a function of PC-MHI, demographics, and clinical covariates. Of 181 patients in the PC-MHI program, 60%/18% returned for mental/medical care within 1 month, and 82%/74% within 1 year. Sixty-one percent (1,503) were still using the VA in FY09. Short-term mental care was related to prior-year PC-MHI. Consistent correlates of short- and long-term mental/medical care included physical comorbidity and Priority 1 status. Most patients attended mental health appointments subsequent to PC-MHI, and PC-MHI was correlated with mental health treatment retention in adjusted models for our cohort. Need for treatment, notably VA Priority 1 status and physical comorbidity, were the primary correlates of care-seeking. Developing innovative approaches to engaging new veterans in care remains imperative as multiple options will be necessary to meet the needs of these complex patients. SN - 1939-148X UR - https://www.unboundmedicine.com/medline/citation/22545824/Primary_care_mental_health_integration_and_treatment_retention_among_Iraq_and_Afghanistan_war_veterans_ L2 - http://content.apa.org/journals/ser/9/4/336 DB - PRIME DP - Unbound Medicine ER -