2019 HSR&D/QUERI National Conference

4088 — Initial Validation of the Perceived Access Inventory (PAI) for Mental Health Services

Lead/Presenter: Jeff Pyne,  COIN - North Little Rock
All Authors: Pyne JM (Center for Mental Health Outcomes Research), Kelly PA (Southeast Louisiana Veterans Healthcare System), Fischer EP (Center for Mental Health Outcomes Research) Miller CJ (Center for Healthcare Organization and Implementation Research) Wright P (University of Arkansas for Medical Sciences) Zamora K (San Francisco VA Healthcare System) Koenig CJ (San Francisco State University) Seal K (San Francisco VA Healthcare System) Fortney JC (Center of Innovation for Veteran-Centered and Value-Driven Care)

Access to care, including mental health care, continues to be a priority for VHA. We used Veteran-centered methods to develop the 43-item Perceived Access Inventory (PAI). We present findings on concurrent validity.

The PAI was developed from qualitative interviews with rural and urban Veterans across three VISNs and includes five domains: Logistics (5 items), Culture (3 items), Digital (9 items), Systems of Care (13 items), and Experiences of Care (13 items). Each item has two parts. Part 1 is a Yes = 1/No = 0 question which assesses the presence/prevalence of a potential barrier, e.g., "did you have to travel a long distance to get VA mental healthcare?". Part 2, administered only to those who respond "Yes" to Part 1, assesses the interference of that barrier with getting needed VA mental healthcare (not at all = 1 to completely = 5). Higher scores indicate more potential barriers/greater interference. We recruited a new sample of 99 Veterans from the same three VISNs to participate in the validation study. Opt-out letters were sent to Veterans who screened positive for depression, PTSD, or alcohol use disorder. Telephone interviews included the PAI, the 14-item Hoge Perceived Barriers to Seeking Mental Health Services, and the 8-item Client Satisfaction Questionnaire (CSQ).

Mean age of the sample was 51 years, 77% male, 65% Caucasian, 49% rural. Part 1 and Part 2 scores correlated significantly with Hoge scores (both r > 0.50, p < 0.001), CSQ (both r > -0.50, p < 0.001), and age (both r > -0.25, p < 0.01). Hoge and CSQ scores were also correlated (r = -0.38, p < 0.001).

PAI concurrent validity is supported by strong correlations with the CSQ and gold standard Hoge scale. Given similar correlation magnitudes between PAI Parts 1 and 2 with Hoge, Part 1 scores may be enough for aggregated analyses; eliminating Part 2 questions would reduce respondent burden. However, the additional information provided by Part 2 may be useful for developing patient-level access interventions.

The PAI provides the patient perspective to inform development and testing of access interventions for Veterans who use VA mental health services. An additional version is available for Veterans who receive care through Choice.