Transition from military to VHA care: Psychiatric health services for Iraq/Afghanistan combat-wounded
Transition from military to VHA care: Psychiatric health services for Iraq/Afghanistan combat-wounded
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DOI：
10.1016/j.jad.2010.10.017
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发表时间：
2011-04-01
影响因子：
6.6
通讯作者：
Lawrence, Valerie A.
中科院分区：
文献类型：
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作者：
Copeland, Laurel A.;Zeber, John E.;Lawrence, Valerie A.
目的：从阿富汗和伊拉克战争（OEF/OIF）退伍军人报告的精神困扰，特别是情感障碍的高发病率。确保跨机构护理的连续性是国防部（DOD）和退伍军人健康管理局（VHA）的优先事项，但这一过程没有受到监测，也没有整合医疗记录。本研究评估了从国防部过渡到VHA和随后的精神病护理服务人员创伤受伤OEF/OIF.Methods：住院病人在国防部创伤治疗设施出院FY 02-FY 06（n = 994）通过档案数据（n = 216 OEF/OIF退伍军人）被跟踪到VHA。结果：VHA用户是9%的女性，15%的西班牙裔，平均年龄32（SD= 10;范围19-59）。没有国防部住院患者被诊断为创伤后应激障碍（PTSD）; 21%的人有其他精神健康诊断，主要是药物滥用。在VHA中，38%在国防部出院后6个月内寻求护理; 75%在1年内。随着时间的推移，VHA的使用率增加，在2007 - 2009财年，88-89%的过渡队列寻求治疗。大多数人获得了VHA心理健康服务（81%），并有VHA精神病诊断（71%）;一半符合抑郁症（27%）或PTSD（38%）的标准。在2009财年，接受精神科治疗的患者的治疗保留率显著更高：98%比未接受精神科治疗的患者的62%（卡方（2）=53.3; p
Objective: Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DOD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF.Methods: Inpatients at a DoD trauma treatment facility discharged in FY02-FY06 (n = 994) were tracked into the VHA via archival data (n = 216 OEF/OIF veterans). Mental health utilization in both systems was analyzed.Results: VHA users were 9% female, 15% Hispanic; mean age 32 (SD= 10; range 19-59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21% had other mental health diagnoses, primarily drug abuse. In the VHA, 38% sought care within 6 months of DoD discharge; 75% within 1 year. VHA utilization increased over time, with 88-89% of the transition cohort seeking care in FY07-FY09. Most accessed VHA mental health services (81%) and had VHA psychiatric diagnoses (71%); half met criteria for depression (27%) or PTSD (38%). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98% vs 62% of those not receiving psychiatric care (chi(2)=53.3; p