title: Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women.
abstract: 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.
authors.affiliation: Mental Illness Research, Education and Clinical Center, University of Washington School of Medicine, Seattle, WA, USA. djdobie@u.washington.edu
authors.forename: Dorcas J
authors.initials: DJ
authors.lastname: Dobie
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: Kay M
authors.initials: KM
authors.lastname: Johnson
authors.forename: Tracy
authors.initials: T
authors.lastname: Simpson
authors.forename: Andrew C
authors.initials: AC
authors.lastname: David
authors.forename: Katharine
authors.initials: K
authors.lastname: Bradley
mesh_terms: 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