Article

Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women.

Mental Illness Research, Education and Clinical Center, University of Washington School of Medicine, Seattle, WA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2006; 21 Suppl 3:S58-64. DOI: 10.1111/j.1525-1497.2006.00376.x
Source: PubMed

ABSTRACT Women with posttraumatic stress disorder (PTSD) report poor health, but associations with health care utilization are understudied.
To determine associations between medical/surgical utilization and PTSD in female Veterans Affairs (VA) patients.
Prospective comparison of utilization rates between women screening positive or negative for PTSD on a mailed survey.
Women receiving care at an urban VA medical center between October 1996 and January 2000.
Survey responses, including a validated screen for PTSD (PCL-C), and VA utilization data through September 2002.
Two thousand five hundred and seventy-eight (2,578) women (78% of those eligible) completed the PCL-C; 858 (33%) of them screened positive for PTSD (PTSD+). In unadjusted models, PTSD+ women had higher rates of medical/surgical hospitalizations and surgical inpatient procedures. Among women ages 35 to 49, mean days hospitalized/100 patients/year was 43.4 (95% CI 26 to 61) for PTSD+ women versus 17.0 (16 to 18) for PTSD negative (PTSD-) women. More PTSD+ women underwent surgical procedures (P<.001). Mean annual outpatient visits were significantly higher among PTSD+ women, including: emergency department (ED) (1.1 [1.0 to 1.2] vs 0.6 [0.5 to 0.6]), primary care (3.2 [3.0 to 3.4] vs 2.2 [2.1 to 2.3]), medical/surgical subspecialists (2.1 [1.9 to 2.3] vs 1.5 [1.4 to 1.6]), ancillary services (4.1 [3.7 to 4.5] vs 2.4 [2.2 to 2.6]), and diagnostic tests (5.6 [5.1 to 6.1] vs 3.7 [3.4 to 4.0]). In multivariate models adjusted for demographics, smoking, service access, and medical comorbidities, PTSD+ women had greater likelihood of medical/surgical hospitalization (OR=1.37 [1.04 to 1.79]) and of being among the top quartile of patients for visits to the ED, primary care, ancillary services, and diagnostic testing.
Female veterans who screen PTSD+ receive more VA medical/surgical services. Appropriateness of that care deserves further study.

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    ABSTRACT: Objective Posttraumatic stress disorder (PTSD) is associated with higher rates of many medical conditions and higher use of medical healthcare services. Growing evidence suggests that comorbid medical illness in PTSD may in turn be associated with greater use of mental health treatment. However, no study to date has examined the impact of cumulative medical illness burden on PTSD service utilization. Method Data come from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). PTSD was assessed via structured interview and cumulative medical illness burden was assessed via a survey of medical conditions. Logistic regression modeling examined associations between cumulative medical illness burden and odds of receiving PTSD treatment. Results In the final sample of 1599 individuals with current PTSD, controlling for demographic characteristics, insurance status, psychiatric comorbidity, and PTSD symptom count, higher levels of past-year medical illness were associated with increased odds of receiving past-year treatment for PTSD (OR = 1.10; 95% CI = 1.01–1.20 p = 0.029). Conclusions Greater levels of medical illness are associated with increased odds of PTSD service utilization. Greater medical comorbidity may increase the need for PTSD care by exacerbating symptoms or increase contact with medical services promoting PTSD detection and treatment.
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