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Abrams T. Variations in Non-evidence Based Treatment Among Veterans with PTSD. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 5; Phoenix, AZ.
Introduction: Rural veterans comprise a disproportionate share of active duty military personnel and have been identified as a population at risk for inferior healthcare outcomes. Recent work has focused on identifying variations in use of non-evidenced based benzodiazepines (BZD) among veterans with PTSD. Variations in BZD use have found correlations with comorbidity, gender, utilization, and geographic region. However, little is known about BZD use variations among rural veterans with PTSD, and if found to what degree use of BZD may reflect higher comorbidity, issues with access, mental health stigma, or other factors. Methods: A cross-sectional study design was used to identify all veterans with a visit for PTSD (n = 498,081) in fiscal year 2009. BZD use was identified using electronic pharmacy data and defined BZD use by the receipt of at least one prescription fill for 90 days. Rural residence was determined using Rural Urban Commuting Area (RUCA) codes. Chi square tests were used to compare BZD use between rural and urban veterans with multivariate logistic regression models to adjust BZD use for demographics, period of service, utilization, and location of PTSD diagnosis. Results: Average age was 53.8 (SD 14.6) and 93% were male; overall, BZD fills were identified in 30.6% of veterans. Use of BZDs was significantly higher for rural veterans compared to urban veterans (33.2% vs. 29.4%; P < .001). Multivariate logistic regression models indicated that veterans from rural areas were 17% more likely to use a BZD (P < .001). Additionally, veterans from rural areas had fewer outpatient visits (mean 7.9 13.7 versus 9.3 17.0 [P < .001]) and less likely to have an inpatient visit than veterans from urban areas (6.6% vs. 7.5%; P < .001). Conclusions: This study finds that rural veterans with PTSD are more likely to be prescribed non-evidenced based BZD yet at the same time are less likely to utilize outpatient and inpatient services relative to urban veterans. Impact: As BZD use among veterans with PTSD remains high in the VA, efforts to explain the degree to which contributing factors (e.g. access, mental health comorbidity, or stigma) are necessary in order to reduce the use of BZD among veterans with PTSD.
