Integrated Primary Care Clinic Improves Access to Mental Health and Social Services for OEF/OIF Veterans
BACKGROUND:
Despite population-based mental health screening by the military and VA, most OEF/OIF Veterans with mental health problems do not access or receive an adequate course of mental health treatment. In response, system-wide priorities were identified for VA primary care, which motivated the establishment of an OEF/OIF Integrated Care (IC) Clinic at the San Francisco VAMC in April 2007. An initial IC clinic visit consists of three optional sessions with a team of primary care, mental health, and social services providers. This retrospective study evaluated whether an initial IC clinic visit improved mental health and social services use among OEF/OIF Veterans entering primary care at the San Francisco VAMC, compared to Veterans who received usual care (standard primary care visit with referral for a psychosocial visit, as needed). Using VA data, investigators identified 526 OEF/OIF Veterans (male and female) who had their first primary care visit between 4/05 and 4/09.
FINDINGS:
- Compared to OEF/OIF Veterans receiving usual care, OEF/OIF Veterans seen in the Integrated Care (IC) clinic were significantly more likely to have had initial mental health and social work evaluations within 30 days (59% vs. 92% and 56% vs. 77%, respectively). Moreover, IC clinic patients were significantly more likely than usual care patients to have had at least one follow-up specialty mental health visit within 90 days of initiating primary care (42% vs. 29%).
- In adjusted analyses, women Veterans, younger Veterans, and those with positive mental health and TBI screens were significantly more likely to have had mental health and social service evaluations if seen in the IC versus the usual care clinic. For example, women Veterans who presented to the IC clinic were nearly three times more likely to have received initial mental health and social services evaluations within 30 days of initiating primary care.
- While the Integrated Clinic increased initial mental health evaluations, there was no significant increase in longer-term retention in specialty mental health services among Veterans who screened positive for mental health problems.
- The IC clinic significantly increased initial mental health care for OEF/OIF Veterans over and beyond improvements already occurring over time in primary care at the San Francisco VAMC. Whereas 25% of Veterans seen in the usual primary care clinic before April 2007 had at least one mental health evaluation within 30 days of initiating primary care, that figure increased to 59% among those who presented to primary care after April 2007 and 92% among those who presented to the IC clinic after 2007.
LIMITATIONS:
- These results are based on administrative data from only one VAMC.
- Investigators did not have access to data on non-VA mental health and social services utilization.
AUTHOR/FUNDING INFORMATION:
This study was funded by DoD. Dr. Seal is part of HSR&D’s Program to Improve Care for Veterans with Complex Comorbid Conditions, San Francisco.
Seal K, Cohen G, Bertenthal D, et al. Reducing Barriers to Mental Health and Social Services for Iraq and Afghanistan Veterans: Outcomes of an Integrated Primary Care Clinic. Journal of General Internal Medicine June 7, 2011;e-pub ahead of print.
