title: Utilization of primary care by veterans with psychiatric illness in the National Department of Veterans Affairs Health Care System.
abstract: BACKGROUND
  Psychiatric illness is associated with increased medical morbidity and mortality. Studies of primary care utilization by patients with psychiatric disorders have been limited by nonrepresentative samples and confounding by medical co-morbidity.
  
  
  OBJECTIVE
  To determine whether patients with psychiatric disorders use primary care services differently than patients without these disorders, after controlling for medical co-morbidity.
  
  
  METHODS
  Data from the 1999 Large Health Survey of Veterans (LHS) (n = 559,985) were linked to VA administrative data in order to identify veterans who received primary care. After adjusting for sociodemographic and clinical characteristics, medical co-morbidity, and facility characteristics, multivariate logistic regression was used to evaluate whether seven psychiatric diagnoses were associated with an increased or decreased likelihood of any primary care visit over 12 months.
  
  
  RESULTS
  Veterans with either schizophrenia, bipolar disorder or a drug use disorder were less likely to have had any primary care visit during the study period: [OR 0.61, 95% CI 0.59 to 0.63], [OR 0.63, 95% CI 0.60 to 0.67] and [OR 0.88, 95% CI 0.83 to 0.92], respectively, than veterans without these diagnoses, even after controlling for medical co-morbidity. Among patients with any primary care utilization, those with six of the seven psychiatric diagnoses had fewer visits in the study period.
  
  
  CONCLUSIONS
  Patients with schizophrenia, bipolar disorder or drug use disorders use less primary care than patients without these disorders. Interventions are needed to increase engagement in primary care by these vulnerable groups.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA. lydia.chwastiak@yale.edu
authors.forename: Lydia A
authors.initials: LA
authors.lastname: Chwastiak
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology
references.citation: Acta Psychiatr Scand. 2006 Apr;113(4):298-305
references.pmid: 16638074
references.citation: Psychiatr Serv. 2003 Aug;54(8):1158-60
references.pmid: 12883146
references.citation: Med Care. 2002 Feb;40(2):129-36
references.pmid: 11802085
references.citation: J Ambul Care Manage. 2006 Oct-Dec;29(4):310-9
references.pmid: 16985389
references.citation: Psychiatr Serv. 2002 Nov;53(11):1456-60
references.pmid: 12407275
references.citation: Psychosom Med. 2005 Jan-Feb;67(1):1-8
references.pmid: 15673617
references.citation: J Ambul Care Manage. 2004 Jul-Sep;27(3):281-95
references.pmid: 15287217
references.citation: J Clin Psychiatry. 1999;60 Suppl 21:10-5
references.pmid: 10548136
references.citation: J Nerv Ment Dis. 2006 Jun;194(6):404-10
references.pmid: 16772856
references.citation: Am J Addict. 2007 Mar-Apr;16(2):101-10
references.pmid: 17453611
references.citation: Am J Psychiatry. 1998 Dec;155(12):1775-7
references.pmid: 9842793
references.citation: Adm Policy Ment Health. 2005 Jan;32(3):267-83
references.pmid: 15844848
references.citation: Br J Psychiatry. 2000 Sep;177:212-7
references.pmid: 11040880
references.citation: Schizophr Res. 2006 Sep;86(1-3):15-22
references.pmid: 16884895
references.citation: Am J Psychiatry. 2004 Dec;161(12):2317-9
references.pmid: 15569908
references.citation: Psychiatr Serv. 2003 Jun;54(6):854-9
references.pmid: 12773600
references.citation: J Ambul Care Manage. 2006 Jan-Mar;29(1):51-60
references.pmid: 16340619
references.citation: J Nerv Ment Dis. 2000 Apr;188(4):209-16
references.pmid: 10789997
references.citation: Psychosomatics. 2007 Jan-Feb;48(1):31-7
references.pmid: 17209147
references.citation: Med Care. 2003 Apr;41(4):560-70
references.pmid: 12665719
references.citation: Acta Psychiatr Scand. 2006 Apr;113(4):306-13
references.pmid: 16638075
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914
references.citation: J Gen Intern Med. 1999 Sep;14(9):569-80
references.pmid: 10491249
references.citation: J Ambul Care Manage. 2004 Jul-Sep;27(3):263-80
references.pmid: 15287216
references.citation: Ann Intern Med. 2007 Mar 6;146(5):317-25
references.pmid: 17339617
references.citation: Schizophr Bull. 2000;26(4):903-12
references.pmid: 11087022
references.citation: AIDS Patient Care STDS. 2007 Mar;21(3):177-86
references.pmid: 17428185