1136 — Factors Affecting Dual System Mental Health Service Use among Women Veterans using VHA Primary Care

Kimerling R, VA Palo Alto Health Care System; Wong A, VA Palo Alto Health Care System;

Objectives:
Few studies of dual VHA and non-VHA service use have specifically examined mental health services, and few studies have focused on factors affecting dual use among women. We examined determinants of dual VHA and non-VHA mental health (MH) services among women Veteran VHA users.

Methods:
We identified 2466 VHA MH service (inpatient, outpatient, or medication) users from a nationally representative sample of women Veterans (N = 6487, 84% participation rate), linked to VA administrative data. We used logistic regression to model the risk-adjusted odds of dual use of MH services as a function of: access to other sources of care (age over 65, other health coverage, usual source of care); convenience (driving distance, parenting status); and quality perceptions of VHA MH care (overall quality, ease of getting needed care, gender-related comfort, and access to specialized services for women). Equations for convenience factors adjusted for access factors, and those for quality perceptions adjusted for access and convenience factors.

Results:
Dual MH care use was reported by 26.9% of VA MH users. Higher odds of dual use were associated with each construct examined. Access factors included health coverage and a usual source of care outside VA, but not age 65+. Convenience factors included parenting status, but not driving distance. Lower quality ratings for all global and gender-related perceptions of VHA MH care were associated with greater odds of dual use.

Implications:
Access, convenience, and quality perceptions each contributed to the substantial rates of dual system MH service utilization among women Veteran VHA primary care users. Difficulty obtaining needed care and lack of access to specialized services for women may motivate women to seek care outside VHA, given access to convenient alternatives.

Impacts:
Routine inquiry regarding usual source of care and capture of non-VA services (such as MHV blue button use) could facilitate care coordination in MH care. Strategic enhancement of gender tailored MH services may retain more women in VA MH care to prevent care fragmentation. Determinants of dual use may vary by gender. Research on dual system use facilitated by VACAA may benefit from gender stratified models.