Outpatient Medical and Mental Healthcare Utilization Models Among Military Veterans: Results from the 2001 National Survey of Veterans

Disaster Mental Health Institute, The University of South Dakota, Vermillion, SD 57069, USA.
Journal of Psychiatric Research (Impact Factor: 3.96). 09/2008; 42(10):858-67. DOI: 10.1016/j.jpsychires.2007.09.006
Source: PubMed


Using Andersen's (1995) [Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 1995;36:1-10] behavioral model of healthcare use as our theoretical framework, we examined predisposing (i.e., sociodemographic), enabling (i.e., access resources), and need (i.e., illness) models of outpatient medical and mental healthcare utilization among a national sample of US veterans. Participants were 20,048 nationally representative participants completing the 2001 National Survey of Veterans. Outcomes were healthcare use variables for the past year, including the number of Veterans Affairs (VA) and non-VA outpatient healthcare visits, and whether VA and non-VA mental health treatment was used. Univariate results demonstrated that numerous predisposing, enabling and need variables predicted both VA and non-VA healthcare use intensity and mental healthcare use. In multivariate analyses, predisposing, enabling and need variables demonstrated significant associations with both types of healthcare use, but accounted for more variance in mental healthcare use. Need variables provided an additive effect over predisposing and enabling variables in accounting for medical and mental healthcare use, and accounted for some of the strongest effects. The results demonstrate that need remains an important factor that drives healthcare use among veterans and does not seem to be overshadowed by socioeconomic factors that may create unfair disparities in treatment access.

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Available from: Jon Elhai, Feb 16, 2014
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    • "Of particular concern is the well-documented rate of co-occurrence of posttraumatic stress disorder and substance misuse and abuse in this population (e.g., McFall, Mackay, & Donovan, 1992), and how these comorbidities may influence the development of dementia, further complicating multimorbidity and the care needs and use of the health care system (King, 1986; Sorrell & Durham, 2011; Yaffe et al., 2010). Previous literature has documented higher rates of service utilization for each of these mental health conditions separately (Elhai et al., 2008; Kessler et al., 2007), as well as higher rates of mental health care utilization in Vietnam-era and younger cohorts compared with older generations of veterans (Sorrell & Durham, 2011). Thus, there is a growing need for future studies to identify best practices in simultaneously managing these conditions from both an interdisciplinary and population-based standpoint. "
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    ABSTRACT: Within the Veterans Health Administration (VHA), Geriatric Evaluation And Management (GEM) clinics are designed specifically to address the needs of older veterans with complex age-related concerns, including dementia and comorbid medical and mental health conditions. Previous literature describes aging veterans as having greater health care needs compared with age-matched nonveteran samples, and multimorbidity is of particular concern in this population. Using data extracted from electronic medical records (EMRs), the present study describes the demographic characteristics, mental health diagnoses, and health care utilization of a sample of 476 VHA GEM patients with diagnosed cognitive impairment or dementia seen in clinics across Upstate New York. Examination of EMR data demonstrated that in addition to diagnosed cognitive impairment and dementia, over 66% of the sample had at least 1 additional mental health diagnosis coded during the study period. Many were prescribed dementia medications and/or other psychotropic medications, predominantly antidepressants. These veterans utilized a variety of outpatient services, including high rates of mental health consultation subsequent to GEM evaluation, though low rates of mental health follow-up were observed. Results from the current study provide insight into the important role mental health providers such as psychologists and psychiatrists can play as collaborators in interdisciplinary geriatrics care for veterans. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Full-text · Article · Nov 2014 · Psychological Services
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    • "Similar findings have been found among UK military personnel, for whom somatic complaints are more severe among those who had deployed as compared with those who have not deployed (Hotopf et al., 2006). Not surprisingly, US military personnel who report more severe health problems use medical services more frequently (Elhai et al., 2007; Richardson et al., 2006), but those who also have elevated PTSD symptoms make even more frequent medical visits (Hoge et al., 2007). Hoge et al. (2007) reported, for instance, that 20.5% of US soldiers with severe somatic complaints but without PTSD symptoms made two or more medical visits during the previous month, as compared with 37.6% of soldiers with both severe somatic complaints and PTSD symptoms. "
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    ABSTRACT: Research has established clear links among posttraumatic stress disorder (PTSD), somatic symptoms, and general health among conventional force military personnel. It is possible that the same relationships exist among Special Operations Force (SOF) personnel, but there are very few, if any, studies that examine these relationships. This study investigated correlates of general health and medical visits among SOF personnel and found that the interaction of somatic and PTSD symptoms was associated with worse health and more frequent medical visits. Follow-up analyses indicated that the interaction of avoidance symptoms with somatic symptoms was significantly associated with worse health, whereas the interaction of emotional numbing with somatic symptoms significantly contributed to increased medical visits. In addition, the results suggest that a sense of accomplishment among SOF personnel may serve as a protective factor against poor health. The results suggest developing interactions among SOF personnel that promote a sense of achievement to ultimately improve the health of the force.
    Full-text · Article · Feb 2014 · The Journal of nervous and mental disease
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    • "Hierarchical logistic regressions were conducted to determine whether self-reported VHA utilization and nonutilization (both lifetime and past year) could be reliably predicted and if so, by which independent variables; the Wald statistic was used to determine significance (p Ͻ .05). Hierarchical logistic regression was used so that the contributions of the specific aspects of the adapted Andersen model could be examined separately and controlled for sequentially as is typically done when using this model for evaluating factors associated with health care utilization (see Elhai et al., 2008; Fasoli et al., 2010). The blocks of variables were entered in accordance with Andersen's model as follows: demographic and sociocultural factors (i.e., age, gender with female as the reference group), GLB-adapted health belief factor (concern about GLBrelated stigma at VHA), enabling factors (i.e., family income, service connection, employment status, years since left military), clinical need factors (i.e., PTSD diagnostic screen status, SF-8 physical component scale score), and GLB-related negative military experiences (i.e., severity of anxiety about concealing GLB identity, history of GLB investigation or punishment, history of GLB-related interpersonal trauma). "
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    ABSTRACT: According to recent census reports, nearly a million veterans have a same-sex partner, yet little is known about them or their use of Veterans Health Care Administration (VHA) services. Gay, lesbian, and bisexual (GLB) veterans recruited from the community (N = 356) completed an on-line survey to assess their rates of VHA utilization and whether they experience specific barriers to accessing VHA services. Andersen's model of health care utilization was adapted to provide an analytic and conceptual framework. Overall, 45.5% reported lifetime VHA utilization and 28.7% reported past-year VHA utilization. Lifetime VHA health care utilization was predicted by positive service connection, positive screen for both posttraumatic stress disorder (PTSD) and depression, and history of at least one interpersonal trauma during military service related to respondent's GLB status. Past-year VHA health care utilization was predicted by female gender, positive service connection, positive screen for both PTSD and depression, lower physical functioning, a history of military interpersonal trauma related to GLB status, and no history of stressful experiences initiated by the military to investigate or punish GLB status. Rates of VHA utilization by GLB veterans in this sample are comparable to those reported by VHA Central Office for all veterans. Of those who utilized VHA services, 33% reported open communication about their sexual orientation with VHA providers. Twenty-five percent of all participants reported avoiding at least one VHA service because of concerns about stigma. Stigma and lack of communication between GLB veterans and their providers about sexual orientation are areas of concern for VHA. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Full-text · Article · May 2013 · Psychological Services
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