Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women.
BACKGROUND
Women with posttraumatic stress disorder (PTSD) report poor health, but associations with health care utilization are understudied.


OBJECTIVE
To determine associations between medical/surgical utilization and PTSD in female Veterans Affairs (VA) patients.


METHODS
Prospective comparison of utilization rates between women screening positive or negative for PTSD on a mailed survey.


METHODS
Women receiving care at an urban VA medical center between October 1996 and January 2000.


METHODS
Survey responses, including a validated screen for PTSD (PCL-C), and VA utilization data through September 2002.


RESULTS
Two thousand five hundred and seventy-eight (2,578) women (78% of those eligible) completed the PCL-C; 858 (33%) of them screened positive for PTSD (PTSD+). In unadjusted models, PTSD+ women had higher rates of medical/surgical hospitalizations and surgical inpatient procedures. Among women ages 35 to 49, mean days hospitalized/100 patients/year was 43.4 (95% CI 26 to 61) for PTSD+ women versus 17.0 (16 to 18) for PTSD negative (PTSD-) women. More PTSD+ women underwent surgical procedures (P<.001). Mean annual outpatient visits were significantly higher among PTSD+ women, including: emergency department (ED) (1.1 [1.0 to 1.2] vs 0.6 [0.5 to 0.6]), primary care (3.2 [3.0 to 3.4] vs 2.2 [2.1 to 2.3]), medical/surgical subspecialists (2.1 [1.9 to 2.3] vs 1.5 [1.4 to 1.6]), ancillary services (4.1 [3.7 to 4.5] vs 2.4 [2.2 to 2.6]), and diagnostic tests (5.6 [5.1 to 6.1] vs 3.7 [3.4 to 4.0]). In multivariate models adjusted for demographics, smoking, service access, and medical comorbidities, PTSD+ women had greater likelihood of medical/surgical hospitalization (OR=1.37 [1.04 to 1.79]) and of being among the top quartile of patients for visits to the ED, primary care, ancillary services, and diagnostic testing.


CONCLUSIONS
Female veterans who screen PTSD+ receive more VA medical/surgical services. Appropriateness of that care deserves further study.
Dobie
Dorcas J
DJ
Mental Illness Research, Education and Clinical Center, University of Washington School of Medicine, Seattle, WA, USA. djdobie@u.washington.edu
Maynard
Charles
C
Kivlahan
Daniel R
DR
Johnson
Kay M
KM
Simpson
Tracy
T
David
Andrew C
AC
Bradley
Katharine
K
D000328:Adult; D005006:Ethnicity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D016387:Women's Health