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Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens.
Psychiatr Serv. 2016 Jan; 67(1):94-100.PS

Abstract

OBJECTIVE

The study examined whether same-day integrated mental health services are associated with increased diagnosis and treatment initiation among primary care patients with positive posttraumatic stress disorder (PTSD) screens.

METHODS

Data were from a national sample of Veterans Health Administration (VHA) primary care patients with a positive PTSD screen (N=21,427). Patients were assessed for PTSD diagnosis and treatment initiation on the screening day and ≤ 7 days, ≤ 12 weeks, ≤ 6 months, and ≤ 1 year after screening positive. The service setting on screening day was categorized as primary care only, same-day primary care-mental health integration (PC-MHI), or same-day specialty mental health care. Multivariable generalized estimating equations logistic regression was used to estimate associations between category of screening day services and diagnosis and treatment initiation, with adjustment for demographic characteristics, prior psychiatric diagnoses, prior VHA service utilization, and PTSD screen score.

RESULTS

Of the 21,427 patients with positive PTSD screens, 10,809 (50.4%) received a diagnosis within one year of screening positive. Same-day PC-MHI services were associated with greater odds of PTSD diagnosis, both on the same day as (odds ratio [OR]=2.23) and one year (OR=1.67) after screening positive compared with primary care-only services (p<.001). Among those who received a diagnosis on the same day as their positive screen, same-day PC-MHI services were associated with increased odds of initiating PTSD treatment (OR=3.39) within 12 weeks of diagnosis, compared with primary care only (p<.001).

CONCLUSIONS

Same-day integrated mental health services may help facilitate PTSD diagnosis and treatment initiation after a positive screen.

Authors+Show Affiliations

Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu).Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu).Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu).Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu).

Pub Type(s)

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

Language

eng

PubMed ID

26423103

Citation

Bohnert, Kipling M., et al. "Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens." Psychiatric Services (Washington, D.C.), vol. 67, no. 1, 2016, pp. 94-100.
Bohnert KM, Sripada RK, Mach J, et al. Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens. Psychiatr Serv. 2016;67(1):94-100.
Bohnert, K. M., Sripada, R. K., Mach, J., & McCarthy, J. F. (2016). Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens. Psychiatric Services (Washington, D.C.), 67(1), 94-100. https://doi.org/10.1176/appi.ps.201500035
Bohnert KM, et al. Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens. Psychiatr Serv. 2016;67(1):94-100. PubMed PMID: 26423103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens. AU - Bohnert,Kipling M, AU - Sripada,Rebecca K, AU - Mach,Jennifer, AU - McCarthy,John F, Y1 - 2015/10/01/ PY - 2015/10/2/entrez PY - 2015/10/2/pubmed PY - 2016/10/8/medline SP - 94 EP - 100 JF - Psychiatric services (Washington, D.C.) JO - Psychiatr Serv VL - 67 IS - 1 N2 - OBJECTIVE: The study examined whether same-day integrated mental health services are associated with increased diagnosis and treatment initiation among primary care patients with positive posttraumatic stress disorder (PTSD) screens. METHODS: Data were from a national sample of Veterans Health Administration (VHA) primary care patients with a positive PTSD screen (N=21,427). Patients were assessed for PTSD diagnosis and treatment initiation on the screening day and ≤ 7 days, ≤ 12 weeks, ≤ 6 months, and ≤ 1 year after screening positive. The service setting on screening day was categorized as primary care only, same-day primary care-mental health integration (PC-MHI), or same-day specialty mental health care. Multivariable generalized estimating equations logistic regression was used to estimate associations between category of screening day services and diagnosis and treatment initiation, with adjustment for demographic characteristics, prior psychiatric diagnoses, prior VHA service utilization, and PTSD screen score. RESULTS: Of the 21,427 patients with positive PTSD screens, 10,809 (50.4%) received a diagnosis within one year of screening positive. Same-day PC-MHI services were associated with greater odds of PTSD diagnosis, both on the same day as (odds ratio [OR]=2.23) and one year (OR=1.67) after screening positive compared with primary care-only services (p<.001). Among those who received a diagnosis on the same day as their positive screen, same-day PC-MHI services were associated with increased odds of initiating PTSD treatment (OR=3.39) within 12 weeks of diagnosis, compared with primary care only (p<.001). CONCLUSIONS: Same-day integrated mental health services may help facilitate PTSD diagnosis and treatment initiation after a positive screen. SN - 1557-9700 UR - https://www.unboundmedicine.com/medline/citation/26423103/Same_Day_Integrated_Mental_Health_Care_and_PTSD_Diagnosis_and_Treatment_Among_VHA_Primary_Care_Patients_With_Positive_PTSD_Screens_ L2 - https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201500035?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -