Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care–Mental Health Integration services

• Published in: General hospital psychiatry Vol. 35; no. 1; pp. 66 - 70
• Main Authors: Bohnert, Kipling M., Pfeiffer, Paul N., Szymanski, Benjamin R., McCarthy, John F.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.01.2013; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cohort Studies; Continuation of mental health care; Continuity of Patient Care; Female; Humans; Logistic Models; Male; Medical sciences; Mental Disorders - diagnosis; Mental Disorders - therapy; Mental health; Mental Health Services - organization & administration; Middle Aged; Organization of mental health. Health systems; Primary care mental health; Primary Health Care - methods; Primary Health Care - organization & administration; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Referral and Consultation; Retrospective Studies; Social psychiatry. Ethnopsychiatry; Time Factors; United States; United States Department of Veterans Affairs; Veterans - psychology; Veterans Health Administration; Young Adult; United States; North America; America; Continuation of mental health care; Veterans Health Administration; Primary care mental health; Continuity of care; Social environment; Human; Managed care; Primary health care; Mental health; Health service; Treatment; Mental disorder; Diagnosis; Secondary analysis; Veteran; Public health
• ISSN: 0163-8343; 1873-7714; 1873-7714
• DOI: 10.1016/j.genhosppsych.2012.09.002

For patients with an initial primary care (PC) encounter in the Veterans Health Administration (VHA) that included a mental health diagnosis, we evaluate whether same-day receipt of Primary Care–Mental Health Integration (PC-MHI) services is associated with the likelihood of receiving a subsequent mental-health-related encounter in the following 90 days. Using VHA administrative data, we identified 9046 patients who received VHA care for the first time in fiscal year 2009, received a PC encounter that included a mental health diagnosis on the first day of their VHA services and initiated care at a VHA facility that provided PC-MHI services. Using multivariable generalized estimating equations logistic regression, we examined whether receipt of same-day PC-MHI was associated with receipt of a subsequent encounter with a mental health diagnosis within 90 days. Analyses adjusted for Operation Enduring Freedom/Operation Iraqi Freedom Veteran status, demographic characteristics, service-connected disability, psychiatric and non-psychiatric diagnoses, and psychotropic medication initiation on the index day of service use. Receipt of same-day PC-MHI services was positively associated with having a mental-health-related encounter in the following 90 days (adjusted odds ratio=2.05; 95% confidence interval=1.66–2.54). PC-MHI services may enhance mental health continuation of care among PC patients with mental health conditions who initiate VHA services.