title: Access to what? An evaluation of the key ingredients to effective advanced mental health access at a VA medical center and its affiliated community-based outreach clinics.
abstract: Initial evaluation of an advanced access clinic developed at a VA medical center (VAMC) found decreased Mental Health wait times and improved quality of care for veterans with depression. Subsequently, modified advanced access models were implemented at affiliated community-based outreach clinics (CBOCs). By comparing each site, we sought to determine whether less resource-intensive models could improve care to the same degree. We assessed contributions of the model's components to the improvement of care (i.e., wait times and depression treatment adequacy). The modified advanced access models led to significant improvements, although no such improvements were seen at 2 control sites. Six features related to rapid access, short-term treatment, and barrier-free access to mental health services accounted for most of the observed improvements. CBOCs can implement limited advanced mental health access models and derive similar improvements to those seen in more extensive models at the VAMCs to which they are affiliated.
authors.affiliation: Department of Psychiatry, Dartmouth Medical School, One Medical Center Drive, Lebanon NH 03756, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Watts
authors.forename: Andrew
authors.initials: A
authors.lastname: Pomerantz
authors.forename: Alicia
authors.initials: A
authors.lastname: Groft
authors.forename: Debra
authors.initials: D
authors.lastname: Scott
authors.forename: Barbara
authors.initials: B
authors.lastname: Street
authors.forename: Yinong
authors.initials: Y
authors.lastname: Young-Xu
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D016009:Chi-Square Distribution; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D017146:Models, Organizational; D011787:Quality of Health Care / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*