Lucinda B Leung1, Jean Yoon1, José J Escarce1, Edward P Post1, Kenneth B Wells1, Catherine A Sugar1, Elizabeth M Yano1, Lisa V Rubenstein1. 1. Dr. Leung, Dr. Yano, and Dr. Rubenstein are with the Center for the Study of Healthcare Innovation, Implementation, and Policy, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Leung is also with the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, where Dr. Escarce is affiliated. Dr. Yano and Dr. Escarce are also with the UCLA Fielding School of Public Health, Los Angeles, where Dr. Sugar is affiliated. Dr. Yano and Dr. Escarce are with the Department of Health Policy and Management, and Dr. Sugar is with the Department of Biostatistics. Dr. Rubenstein is also with RAND Corporation, Santa Monica, California. Dr. Sugar is also with the UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, where Dr. Wells is affiliated. Dr. Wells is also with the UCLA Center for Health Services and Society, Los Angeles. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, and with the Department of General Internal Medicine, University of California, San Francisco, School of Medicine. Dr. Post is with the VA Center for Clinical Management Research and the University of Michigan Medical School, both in Ann Arbor.
Abstract
OBJECTIVE: Primary care-mental health integration (PC-MHI) aims to increase access to general mental health specialty (MHS) care for primary care patients thereby decreasing referrals to non-primary care-based MHS services. It remains unclear whether new patterns of usage of MHS services reflect good mental health care. This study examined the relationship between primary care clinic engagement in PC-MHI and use of different MHS services. METHODS: This was a retrospective longitudinal cohort study of 66,638 primary care patients with mental illnesses in 29 Southern California Veterans Affairs clinics (2008-2013). Regression models used clinic PC-MHI engagement (proportion of all primary care clinic patients who received PC-MHI services) to predict relative rates of general MHS visits and more specialized MHS visits (for example, visits for serious mental illness services), after adjustment for year and clinic fixed effects, other clinic interventions, and patient characteristics. RESULTS: Patients were commonly diagnosed as having depression (35%), anxiety (36%), and posttraumatic stress disorder (22%). For every 1 percentage point increase in a clinic's PC-MHI engagement rate, patients at the clinic had 1.2% fewer general MHS visits per year (p<.001) but no difference in more specialized MHS visits. The reduction in MHS visits occurred among patients with depression (-1.1%, p=.01) but not among patients with psychosis; however, the difference between the subsets was not statistically significant. CONCLUSIONS: Primary care clinics with greater engagement in PC-MHI showed reduced general MHS use rates, particularly for patients with depression, without accompanying reductions in use of more specialized MHS services.
OBJECTIVE: Primary care-mental health integration (PC-MHI) aims to increase access to general mental health specialty (MHS) care for primary care patients thereby decreasing referrals to non-primary care-based MHS services. It remains unclear whether new patterns of usage of MHS services reflect good mental health care. This study examined the relationship between primary care clinic engagement in PC-MHI and use of different MHS services. METHODS: This was a retrospective longitudinal cohort study of 66,638 primary care patients with mental illnesses in 29 Southern California Veterans Affairs clinics (2008-2013). Regression models used clinic PC-MHI engagement (proportion of all primary care clinic patients who received PC-MHI services) to predict relative rates of general MHS visits and more specialized MHS visits (for example, visits for serious mental illness services), after adjustment for year and clinic fixed effects, other clinic interventions, and patient characteristics. RESULTS:Patients were commonly diagnosed as having depression (35%), anxiety (36%), and posttraumatic stress disorder (22%). For every 1 percentage point increase in a clinic's PC-MHI engagement rate, patients at the clinic had 1.2% fewer general MHS visits per year (p<.001) but no difference in more specialized MHS visits. The reduction in MHS visits occurred among patients with depression (-1.1%, p=.01) but not among patients with psychosis; however, the difference between the subsets was not statistically significant. CONCLUSIONS: Primary care clinics with greater engagement in PC-MHI showed reduced general MHS use rates, particularly for patients with depression, without accompanying reductions in use of more specialized MHS services.
Entities:
Keywords:
Primary care, Veterans issues, Utilization patterns & review, Mental health services
Authors: Victor Puac-Polanco; Lucinda B Leung; Robert M Bossarte; Corey Bryant; Janelle N Keusch; Howard Liu; Hannah N Ziobrowski; Wilfred R Pigeon; David W Oslin; Edward P Post; Ronald C Kessler Journal: J Am Board Fam Med Date: 2021 Mar-Apr Impact factor: 2.657
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