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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

National Meeting 2009

3008 — Patient-Provider Communication among Veterans with Serious Mental Illnesses and Substance Use Disorders

Bohnert AB (VA National Serious Mental Illness Treatment Research and Evaluation Center (SMITREC)), Zivin K (VA (SMITREC)), Welsh DE (VA (SMITREC)), Kilbourne AM (VA (SMITREC))

Better patient-provider communication is associated with optimal health outcomes, including improved medication adherence, higher treatment satisfaction, screening, and overall treatment success. Research suggests that many individuals with serious mental illness (SMI) do not feel their communication with their provider is adequate. Poor patient-provider communication is associated with health disparities; however, the degree to which patient-provider communication differs between individuals with and without mental disorders has not been studied. The present study examined the relationship between SMI and substance use disorder (SUD) diagnosis and patient-provider communication in a national sample of veterans.

This study included VA patients who: 1) completed the Large Health Survey of Veteran Enrollees (LHSV) study in 1999, and 2) either had an SMI diagnosis based on the VA National Psychosis Registry or who were in a national random sample of non-SMI VA patients that same year (total N = 8089). The LHSV included questions on patient sociodemographics, treatment factors, and patient-provider communication. Four binary items assessed communication: the doctor’s thoroughness, attentiveness, explanation of diagnosis and treatment, and knowledge of the patient’s worries.

In a latent class analysis of the four communication items, the best-fitting model indicated that there were three classes in the sample, grouped by having very good, good, and poor communication. In multivariable regression clustered by VA facility, SMI (OR = 1.42) and SUD (OR = 1.20) diagnoses were independently associated with being in the “poor” compared to the “very high” communication class, even after controlling for patient age, gender, race, education, and trust in their doctor.

Veterans with SMI and with SUD diagnoses report worse communication with their providers, which may lead to worse treatment outcomes. This finding may be due to the complexity of care for persons with SMIs and SUDs.

Improving patient-provider communication is crucial for improving quality, outcomes, and ultimately, reducing health disparities in vulnerable veteran populations. Interventions focused on improving communication between SMI and SUD patients and providers should be promoted within VA settings.

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