Primary Care Mental Health Integration and Treatment Retention Among Iraq and Afghanistan War Veterans
Primary Care Mental Health Integration and Treatment Retention Among Iraq and Afghanistan War Veterans
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DOI：
10.1037/a0028308
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发表时间：
2012-11-01
影响因子：
2.3
通讯作者：
Copeland，Laurel A.
中科院分区：
文献类型：
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作者：
Tsan，Jack Y.;Zeber，John E.;Copeland，Laurel A.
尽管来自伊拉克/阿富汗（OEF/OIF）的退伍军人中创伤后应激障碍（PTSD）和医疗并发症的患病率很高，但让这些患者参与医疗保健是具有挑战性的。初级保健-心理健康一体化（PC-MHI）是退伍军人健康管理局（VA）的一项倡议，旨在改善初级保健中获得心理健康护理的机会。本研究检查了首次PC-MHI访视和下一次精神/医疗护理访视（如果有）之间的滞后，以及PC-MHI与短期（随后一年）和长期（4年后）使用VA的关系。我们确定了2,470 OEF/OIF退伍军人在2006财政年度（FY 06）在区域VA医疗保健系统接受护理。无条件生存分析模拟了下一次精神/医疗访视的时间，逻辑回归模拟了短期和长期护理作为PC-MHI、人口统计学和临床协变量的函数。在PC-MHI项目的181名患者中，60%/18%在1个月内返回接受精神/医疗护理，82%/74%在1年内返回。百分之六十一（1,503）仍在使用VA在FY 09。短期精神护理与前一年的PC-MHI有关。短期和长期精神/医疗护理的一致相关性包括身体合并症和优先级1状态。大多数患者在PC-MHI之后参加了心理健康预约，并且在我们队列的调整模型中，PC-MHI与心理健康治疗保留相关。治疗需要，特别是VA优先1状态和身体合并症，是寻求护理的主要相关因素。开发创新的方法，让新的退伍军人参与护理仍然是当务之急，因为多种选择将是必要的，以满足这些复杂的病人的需求。（PsycInfo数据库记录（c）2016阿帕，保留所有权利）
Despite the high prevalence of posttraumatic stress disorder (PTSD) and medical comorbidity among veterans from Iraq/Afghanistan (OEF/OIF), keeping these patients engaged in health care is challenging. Primary Care–Mental Health Integration (PC-MHI), an initiative in the Veterans Health Administration (VA), sought to improve access to mental health care from within primary care. This study examined the lag between first PC-MHI visit and next mental/medical care visit, if any, and the relationship of PC-MHI with short-term (subsequent year) and long-term (4 years later) use of VA. We identified 2,470 OEF/OIF veterans receiving care during fiscal year 2006 (FY06) in a regional VA health care system. Unconditional survival analysis modeled time to next mental/medical visit and logistic regression modeled short-and long-term care as a function of PC-MHI, demographics, and clinical covariates. Of 181 patients in the PC-MHI program, 60%/18% returned for mental/medical care within 1 month, and 82%/74% within 1 year. Sixty-one percent (1,503) were still using the VA in FY09. Short-term mental care was related to prior-year PC-MHI. Consistent correlates of short-and long-term mental/medical care included physical comorbidity and Priority 1 status. Most patients attended mental health appointments subsequent to PC-MHI, and PC-MHI was correlated with mental health treatment retention in adjusted models for our cohort. Need for treatment, notably VA Priority 1 status and physical comorbidity, were the primary correlates of care-seeking. Developing innovative approaches to engaging new veterans in care remains imperative as multiple options will be necessary to meet the needs of these complex patients.(PsycINFO Database Record (c) 2016 APA, all rights reserved)