title: Access-related measures and out-of-system utilization among veterans with bipolar disorder.
abstract: OBJECTIVE
  This study examined associations between access-related measures and out-of-system health services utilization (general medicine and mental health services) among patients with bipolar disorder at a U.S. Department of Veterans Affairs (VA) medical center.
  
  
  METHODS
  VA patients (N=391) with bipolar disorder answered questions about health services access (non-VA insurance coverage, travel distance to their VA facility, service-connected disability status, and difficulty receiving needed mental health care) and out-of-system services utilization. Multivariable Tobit regression was used to evaluate associations between access measures and propensity to receive out-of-system services.
  
  
  RESULTS
  More than half the veterans (56%) reported some non-VA utilization. Out-of-system utilization was more likely among patients who were married, younger, homeless, with private insurance, without service-connected disabilities, and who reported access difficulties.
  
  
  CONCLUSIONS
  Out-of-system utilization was associated with multiple measures of access and indicators specific to VA and non-VA providers. Enhancing health system access for patients with bipolar disorder may reduce out-of-system utilization, potentially enhancing continuity of care.
authors.affiliation: U.S. Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48113-0170, USA. john.mccarthy2@va.gov
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000628:therapy; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans / Q000523:psychology*; D055815:Young Adult