title: Primary care-mental health integration and treatment retention among Iraq and Afghanistan war veterans.
abstract: Despite the high prevalence of posttraumatic stress disorder (PTSD) and medical comorbidity among veterans from Iraq/Afghanistan (OEF/OIF), keeping these patients engaged in health care is challenging. Primary Care-Mental Health Integration (PC-MHI), an initiative in the Veterans Health Administration (VA), sought to improve access to mental health care from within primary care. This study examined the lag between first PC-MHI visit and next mental/medical care visit, if any, and the relationship of PC-MHI with short-term (subsequent year) and long-term (4 years later) use of VA. We identified 2,470 OEF/OIF veterans receiving care during fiscal year 2006 (FY06) in a regional VA health care system. Unconditional survival analysis modeled time to next mental/medical visit and logistic regression modeled short- and long-term care as a function of PC-MHI, demographics, and clinical covariates. Of 181 patients in the PC-MHI program, 60%/18% returned for mental/medical care within 1 month, and 82%/74% within 1 year. Sixty-one percent (1,503) were still using the VA in FY09. Short-term mental care was related to prior-year PC-MHI. Consistent correlates of short- and long-term mental/medical care included physical comorbidity and Priority 1 status. Most patients attended mental health appointments subsequent to PC-MHI, and PC-MHI was correlated with mental health treatment retention in adjusted models for our cohort. Need for treatment, notably VA Priority 1 status and physical comorbidity, were the primary correlates of care-seeking. Developing innovative approaches to engaging new veterans in care remains imperative as multiple options will be necessary to meet the needs of these complex patients.
authors.affiliation: Department of Veterans Affairs. Jack.Tsan@va.gov
authors.forename: Jack Y
authors.initials: JY
authors.lastname: Tsan
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Stock
authors.forename: Fangfang
authors.initials: F
authors.lastname: Sun
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D000369:Aged, 80 and over; D003130:Combat Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D054542:Iraq War, 2003-2011; D008134:Long-Term Care / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D013781:Texas; D014481:United States; D014600:Utilization Review; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult