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Gen Hosp Psychiatry. 2013 Jan-Feb;35(1):66-70. doi: 10.1016/j.genhosppsych.2012.09.002. Epub 2012 Oct 9.

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.

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1
Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA. kiplingb@med.umich.edu

Abstract

OBJECTIVE:

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.

METHOD:

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.

RESULTS:

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).

CONCLUSIONS:

PC-MHI services may enhance mental health continuation of care among PC patients with mental health conditions who initiate VHA services.

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