title: Service utilization among Iraq and Afghanistan veterans screening positive for traumatic brain injury.
abstract: We compared mental health outpatient, primary care, and emergency care service utilization among veterans screening TBI positive (S-TBI⁺) versus those screening TBI negative (S-TBI⁻) and describe associations between TBI-related symptoms and health service utilization. Our study population consisted of 1746 Iraq and Afghanistan veterans in VA care screened for TBI between April 1, 2007 and June 1, 2010. Rates of mental health outpatient, primary care, and emergency services utilization were greater for S-TBI(+) veterans, compared with S-TBI(-) veterans, even after adjusting for mental health screen results. Irritability on the initial TBI screen was associated with increased mental health outpatient utilization rates [incidence rate ratio (IRR), 1.64; 95% confidence interval (CI), 1.18-2.3; p<0.01]. Reports of dizziness (IRR, 1.24; 95% CI, 1.02-1.51; p<0.05) and headaches (IRR, 1.41; 95% CI, 1.16-1.7; p<0.001) were associated with increased primary care utilization rates. Higher utilization rates among veterans who screened positive for TBI were not better explained by screening positive for comorbid mental health problems. Knowing that certain symptoms are more strongly associated with increased utilization in certain health service domains will help to better plan for the care of returning veterans who screen positive for TBI.
authors: San Francisco VA Medical Center, San Francisco, California 94121, USA. Shira.Maguen@va.gov
authors: Shira
authors: S
authors: Maguen
authors: Erin
authors: E
authors: Madden
authors: Karen M
authors: KM
authors: Lau
authors: Karen H
authors: KH
authors: Seal
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001930:Brain Injuries / Q000150:complications*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult