1060 — Use of Whole Health Services Is Associated with Increased Use of Evidence-Based Psychotherapy Among Veterans

Lead/Presenter: Bella Etingen,  COIN - Hines
All Authors: Etingen B (Center of Innovation for Complex Chronic Healthcare (CINCCH)), Smith BM (Center of Innovation for Complex Chronic Healthcare (CINCCH)) Zeliadt SB (Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care) Kaitz JE (Center for Healthcare Organization and Implementation Research (CHOIR)) Barker AM (Center for Healthcare Organization and Implementation Research (CHOIR)) Hyde JK (Center for Healthcare Organization and Implementation Research (CHOIR)) Fix GM (Center for Healthcare Organization and Implementation Research (CHOIR)) Reed DE (Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care) Anderson E (Center for Healthcare Organization and Implementation Research (CHOIR)) Hogan TP (Center for Healthcare Organization and Implementation Research (CHOIR)) Bokhour BG (Center for Healthcare Organization and Implementation Research (CHOIR))

Objectives:
Engagement in evidence-based psychotherapy (EBP) among Veterans with behavioral health conditions is low. The Veterans Health Administration (VHA) is implementing a Whole Health (WH) system of care to promote Veterans’ health and well-being through complementary and integrative health services alongside conventional care and patient-centered approaches intended to engage and empower Veterans to achieve well-being. WH utilization has previously been shown to improve overall Veteran engagement in care, however, less is known about the potential influence that WH utilization may have on access to mental health care. The objective of this analysis was to examine the relationship between Veteran WH service utilization and subsequent engagement in EBP.

Methods:
We conducted a retrospective database analysis using VHA administrative records from 18 geographically diverse VHA facilities where WH is being implemented. We identified Veterans (n = 284,111) with a diagnosis of depression, post-traumatic stress disorder (PTSD) and/or anxiety in fiscal year (FY) 2018 who had a VHA mental healthcare encounter in the year prior to their index date (i.e., date of first WH visit in FY2019; first day of FY2019 for non-users) but no EBP use during that time. EBP use was identified through health factor data available in VHA administrative records. We used multivariate logistic regression to examine the association between Veteran WH utilization and use of an EBP for depression, anxiety, or PTSD within one year following their index date.

Results:
Among the Veterans in our cohort (n = 284,111), 35,468 utilized VHA WH services in FY2019 (12.5%) and 8,430 (3.0%) had EBP use within one year following their index date. When controlling for key demographic, health, and utilization variables, Veterans who had used WH services had 2.3 times higher odds of using an EBP within one year following their index date than those with no WH utilization (CI95%: 2.2-2.5). Associations between utilization of specific WH services (vs. no utilization of that specific service) and use of an EBP in the subsequent year were as follows: Tai Chi (OR: 3.5; CI95%: 3.1-4.0), meditation (OR: 3.5; CI95%: 3.2-3.8), yoga (OR: 3.3; CI95%: 3.0-3.7), guided imagery (OR: 3.0; CI95%: 2.2-3.9), biofeedback (OR: 2.9; CI95%: 2.3-3.6), core WH services (OR: 2.4; CI95%: 2.2-2.5), acupuncture (OR: 2.0; CI95%: 1.9-2.2), massage (OR: 1.9; CI95%: 1.6-2.2), hypnosis (OR: 1.7; CI95%: 1.1-2.7), and chiropractic care (OR: 1.6; CI95%: 1.5-1.8).

Implications:
Our results indicate that engagement with WH services is associated with subsequent engagement in EBP among Veterans with depression, anxiety and/or PTSD. This association was strongest for Tai Chi, meditation, and yoga. These findings suggest integrative therapies and well-being services emphasizing mindfulness, a mind/body connection, and mindful coping skills may act as a gateway to EBP engagement.

Impacts:
Despite widespread availability, Veteran engagement in EBP remains low. Engaging Veterans in WH services may be an effective strategy for increasing use of EBP for mental health diagnoses, underscoring the value of promoting WH approaches for Veterans with mental health concerns. Future interventions intended to promote Veteran access to mental health care and EBP use may benefit from leveraging WH services and therapies.