Primary care satellite clinics and improved access to general and mental health services.
OBJECTIVE
To evaluate the relationship between the implementation of community-based primary care clinics and improved access to general health care and/or mental health care, in both the general population and among people with disabling mental illness.


METHODS
The 69 new community-based primary care clinics in underserved areas, established by the Department of Veterans Affairs (VA) between the last quarter of FY 1995 and the second quarter of FY 1998, including the 21 new clinics with a specialty mental health care component.


METHODS
VA inpatient and outpatient workload files, 1990 U.S. Census data, and VA Compensation and Pension files were used to determine the proportion of all veterans, and the proportion of disabled veterans, living in each U.S. county who used VA general health care services and VA mental health services before and after these clinics began operation.


METHODS
Analysis of covariance was used to compare changes, from late FY 1995 through early FY 1998, in access to VA services in counties in which new primary care clinics were located, in counties in which clinics that included specialized mental health components were located, and for comparison, in other U.S. counties, adjusting for potentially confounding factors.


RESULTS
Counties in which new clinics were located showed a significant increase from the FY 1995-FY 1998 study dates in the proportion of veterans who used general VA health care services. This increase was almost twice as large as that observed in comparison counties (4.2% vs. 2.5%: F = 12.6, df = 1,3118, p = .0004). However, the introduction of these clinics was not associated with a greater use of specialty VA mental health services in the general veteran population, or of either general health care services or mental health services among veterans who received VA compensation for psychiatric disorders. In contrast, in counties with new clinics that included a mental health component the proportion of veterans who used VA mental health services increased to almost three times the proportion in comparison counties (0.87% vs. 0.31%: F = 8.3, df = 1,3091, p = .004).


CONCLUSIONS
Community-based primary care clinics can improve access to general health care services, but a specialty mental health care component appears to be needed to improve access to mental health services.
Rosenheck
R
R
VA Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven 06516, USA.
D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000706:statistics & numerical data; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008507:Medically Underserved Area; D001523:Mental Disorders / Q000628:therapy; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs