Erin P Finley1, Michael Mader2, Mary J Bollinger3, Elizabeth K Haro2, Hector A Garcia2, Alexis K Huynh4, Jacqueline A Pugh1, Mary Jo Pugh1. 1. South Texas Veterans Health Care System, 7400 Merton Minter Boulevard (11C6), San Antonio, TX 78229-4404. 2. The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229. 3. Central Arkansas Veterans Healthcare System, 4300 West 7th Street, Little Rock, AR 72205. 4. VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Abstract
INTRODUCTION: Post-traumatic stress disorder (PTSD) affects nearly one-fifth of Iraq and Afghanistan Veterans (IAV). The Department of Veterans Affairs (VA) has invested in making evidence-based psychotherapies for PTSD available at every VA facility nationwide; however, an unknown number of veterans opt to receive care in the community rather than with VA. We compared PTSD care utilization patterns among Texas IAV with PTSD, an ethnically, geographically, and economically diverse group. METHODS: To identify IAV in Texas with service-connected disability for PTSD, we used a crosswalk of VA administrative data from the Operation Enduring Freedom/Operation Iraqi Freedom Roster and service-connected disability data from the Veterans Benefits Administration. We then surveyed a random sample of 1,128 veterans from the cohort, stratified by sex, rurality, and past use/nonuse of any VA care. Respondents were classified into current utilization groups (VA only, non-VA only, dual care, and no professional PTSD treatment) on the basis of reported PTSD care in the prior 12 months. Responses were weighted to account for sample stratification and for response rate within each strata. Utilization group characteristics were compared to the population mean using the one sample Z-test for proportions, or the t-test for means. A multinomial logistic regression model was used to identify survey variables significantly associated with current utilization group. RESULTS: 249 IAV completed the survey (28.4% response rate). Respondents reported receiving PTSD care: in the VA only (58.3%); in military or community-based settings (including private practitioners) (non-VA only, 8.7%); and in both VA and non-VA settings (dual care, 14.5%). The remainder (18.5%) reported no professional PTSD care in the prior year. Veterans ineligible for Department of Defense care, uncomfortable talking about their problems, and opposed to medication were more likely to receive non-VA care only, whereas those with lower household income, <50% service connection for PTSD, and reporting high stoicism were more likely to receive no professional treatment. The best model constructed from survey variables correctly predicted utilization group 76% of the time, whereas a model constructed only from variables currently available in VA data predicted utilization group correctly 64% of the time. Important variables distinguishing utilization groups included household income, percent PTSD service connection, routine use of VA health care, having non-VA insurance, past PTSD care at a VA facility or at a community-based facility, attitudes regarding medication, discomfort with mental health care seeking, and perceived treatment efficacy in community-based settings. CONCLUSION: These findings suggest that preferences for care setting among IAV with PTSD have less influence on care utilization than actual access factors such as household income and service connection. Given that nearly a quarter of respondents indicated receiving as least some PTSD care in community settings, working toward seamless VA/non-VA care coordination remains an important goal for ensuring high-quality care. Reprint &
INTRODUCTION: Post-traumatic stress disorder (PTSD) affects nearly one-fifth of Iraq and Afghanistan Veterans (IAV). The Department of Veterans Affairs (VA) has invested in making evidence-based psychotherapies for PTSD available at every VA facility nationwide; however, an unknown number of veterans opt to receive care in the community rather than with VA. We compared PTSD care utilization patterns among Texas IAV with PTSD, an ethnically, geographically, and economically diverse group. METHODS: To identify IAV in Texas with service-connected disability for PTSD, we used a crosswalk of VA administrative data from the Operation Enduring Freedom/Operation Iraqi Freedom Roster and service-connected disability data from the Veterans Benefits Administration. We then surveyed a random sample of 1,128 veterans from the cohort, stratified by sex, rurality, and past use/nonuse of any VA care. Respondents were classified into current utilization groups (VA only, non-VA only, dual care, and no professional PTSD treatment) on the basis of reported PTSD care in the prior 12 months. Responses were weighted to account for sample stratification and for response rate within each strata. Utilization group characteristics were compared to the population mean using the one sample Z-test for proportions, or the t-test for means. A multinomial logistic regression model was used to identify survey variables significantly associated with current utilization group. RESULTS: 249 IAV completed the survey (28.4% response rate). Respondents reported receiving PTSD care: in the VA only (58.3%); in military or community-based settings (including private practitioners) (non-VA only, 8.7%); and in both VA and non-VA settings (dual care, 14.5%). The remainder (18.5%) reported no professional PTSD care in the prior year. Veterans ineligible for Department of Defense care, uncomfortable talking about their problems, and opposed to medication were more likely to receive non-VA care only, whereas those with lower household income, <50% service connection for PTSD, and reporting high stoicism were more likely to receive no professional treatment. The best model constructed from survey variables correctly predicted utilization group 76% of the time, whereas a model constructed only from variables currently available in VA data predicted utilization group correctly 64% of the time. Important variables distinguishing utilization groups included household income, percent PTSD service connection, routine use of VA health care, having non-VA insurance, past PTSD care at a VA facility or at a community-based facility, attitudes regarding medication, discomfort with mental health care seeking, and perceived treatment efficacy in community-based settings. CONCLUSION: These findings suggest that preferences for care setting among IAV with PTSD have less influence on care utilization than actual access factors such as household income and service connection. Given that nearly a quarter of respondents indicated receiving as least some PTSD care in community settings, working toward seamless VA/non-VA care coordination remains an important goal for ensuring high-quality care. Reprint &
Authors: Kristin M Mattocks; Kristin Cunningham; A Rani Elwy; Erin P Finley; Clinton Greenstone; Michelle A Mengeling; Steven D Pizer; Megan E Vanneman; Michael Weiner; Lori A Bastian Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Katherine A Dondanville; Brooke A Fina; Casey L Straud; Erin P Finley; Hannah Tyler; Vanessa Jacoby; Tabatha H Blount; John C Moring; Kristi E Pruiksma; Abby E Blankenship; Wyatt R Evans; Mariya Zaturenskaya Journal: Community Ment Health J Date: 2020-07-14
Authors: Erin P Finley; Michael Mader; Elizabeth K Haro; Polly H Noël; Nancy Bernardy; Craig S Rosen; Mary Bollinger; Hector A Garcia; Kathleen Sherrieb; Mary Jo V Pugh Journal: J Behav Health Serv Res Date: 2019-04 Impact factor: 1.505
Authors: Alyson J Littman; Gala True; Emily Ashmore; Tracy Wellens; Nicholas L Smith Journal: BMC Med Res Methodol Date: 2018-08-29 Impact factor: 4.615
Authors: Kathleen E Bickel; Richard Kennedy; Cari Levy; Kathryn L Burgio; F Amos Bailey Journal: J Gen Intern Med Date: 2019-12-02 Impact factor: 5.128