title: Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens.
abstract: OBJECTIVE
  The study examined whether same-day integrated mental health services are associated with increased diagnosis and treatment initiation among primary care patients with positive posttraumatic stress disorder (PTSD) screens.
  
  
  METHODS
  Data were from a national sample of Veterans Health Administration (VHA) primary care patients with a positive PTSD screen (N=21,427). Patients were assessed for PTSD diagnosis and treatment initiation on the screening day and ≤ 7 days, ≤ 12 weeks, ≤ 6 months, and ≤ 1 year after screening positive. The service setting on screening day was categorized as primary care only, same-day primary care-mental health integration (PC-MHI), or same-day specialty mental health care. Multivariable generalized estimating equations logistic regression was used to estimate associations between category of screening day services and diagnosis and treatment initiation, with adjustment for demographic characteristics, prior psychiatric diagnoses, prior VHA service utilization, and PTSD screen score.
  
  
  RESULTS
  Of the 21,427 patients with positive PTSD screens, 10,809 (50.4%) received a diagnosis within one year of screening positive. Same-day PC-MHI services were associated with greater odds of PTSD diagnosis, both on the same day as (odds ratio [OR]=2.23) and one year (OR=1.67) after screening positive compared with primary care-only services (p<.001). Among those who received a diagnosis on the same day as their positive screen, same-day PC-MHI services were associated with increased odds of initiating PTSD treatment (OR=3.39) within 12 weeks of diagnosis, compared with primary care only (p<.001).
  
  
  CONCLUSIONS
  Same-day integrated mental health services may help facilitate PTSD diagnosis and treatment initiation after a positive screen.
authors.affiliation: Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu ).
authors.forename: Kipling M
authors.initials: KM
authors.lastname: Bohnert
authors.affiliation: Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu ).
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Sripada
authors.affiliation: Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu ).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mach
authors.affiliation: Dr. Bohnert and Dr. Sripada are with the Center for Clinical Management Research and all authors are with the Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), U.S. Department of Veterans Affairs (VA), Ann Arbor, Michigan. Dr. Bohnert, Dr. Sripada, and Dr. McCarthy are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: kiplingb@med.umich.edu ).
authors.forename: John F
authors.initials: JF
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health / Q000592:standards*; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*