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Cradock JA, Young AS, Yano EM, Wang M, Lee ML. Evaluating the Impact of Mental Illness on Medical Care Access. Paper presented at: VA HSR&D National Meeting; 2002 Feb 1; Washington, DC.
Objectives: Patients with serious mental illness (SMI) frequently have undetected or untreated medical needs (e.g., diabetes and hypertension), and mortality rates are much higher than in the general population. While little is known regarding why this population is less likely to receive general medical care, potential contributing factors include psychiatric symptoms, difficulty verbalizing concerns, poor insight into their illnesses, and unwillingness to see a medical doctor. These can be challenging patients to treat, and a better understanding of this problem can inform interventions to improve their care. Methods: We examined access to medical care for veterans treated in VISN 22 during fiscal year 2000. Diagnostic, demographic and utilization data were obtained from the VA Outpatient Clinic files at Austin. Two multivariate regression models were developed. Model 1 examined factors affecting the intensity of treatment (number of visits). Model 2 examined lack of preventive care: factors affecting whether veterans over aged 50 received any medical care. Independent variables included psychiatric diagnosis (schizophrenia, bipolar, depression, anxiety, PTSD, substance abuse, no mental disorder), age, gender, marital status, race, GAF, service-connection level, income, and medical diagnoses. Results: Model 1 indicated that patients with each psychiatric diagnosis had less visits than those with no mental disorder (p < .0001). Patients with severe mental illness (schizophrenia and bipolar) were particularly unlikely to receive medical care (p < .0001). Medical visits were more frequent in veterans who were older, female, and had medical diagnoses. Model 2 found that patients aged 50 and older were less likely to have any medical care if they had substance abuse, depression, anxiety, bipolar disorder (p < .0001 for each), or PTSD (p = .03). There was no significant difference for schizophrenia (p = .70). Conclusions: Medical care is less likely for people with psychiatric disorders. This problem is particularly severe for young adults with schizophrenia and PTSD, and for adults with bipolar disorder across the age range. While interventions are needed to improve medical care, these interventions may need to differ according to the population being targeted. Impact statement: This informs the development and dissemination of interventions to improve medical care for veterans with mental illness.