Veterans Administration clinics that integrate primary and mental health care are more successful at getting veterans mental health and social work evaluations than a standard VA primary care clinic, according to a study of Iraq and Afghanistan vets.
According to lead author Karen Seal, M.D., M.P.H., under the conventional VA model, patients are seen by a primary care physician and, if they screen positive for mental illness they are referred to a mental health provider.
Notably, the referral appointment would not necessarily be available the same day, nor in the same clinic.
Under the integrated care model, all patients are referred immediately by their primary care physician to a mental health provider, called the “Post-Deployment Stress Specialist,” and a social worker, called the “Combat Case Manager.” All visits take place during the same appointment, in the same clinic, with no waiting.
The combined clinic approach was beneficial for women veterans, younger veterans, veterans with mental health diagnoses, and veterans who screened positive for traumatic brain injury.
The study is found in the electronic Online First section of the Journal of General Internal Medicine.
“This demonstrates the value of the integrated care clinic model for our veterans, especially those who may be more vulnerable,” said Seal.
The study also showed, however, that the rate of follow-up mental health care – the number of subsequent visits with mental health providers that took place after initial evaluation – was not any higher under the integrated care model than under standard care.
“We are really good at initial engagement, but unfortunately, we are not as successful at helping veterans stay with and complete a course of mental health treatment,” said Seal.
“We need to learn how to help veterans stick with the more difficult first few sessions of PTSD treatment, so they can get through to the other side when they really start to feel better.” Seal said that successful PTSD treatment usually takes nine to 12 sessions.
Researchers examined the medical records of 526 Iraq and Afghanistan veterans who came to San Franciso Veterans Administration Medical Center between 2005 and 2009 for their first primary care visit after returning from combat deployment. Veterans who visited after April 1, 2007 – the date that the Integrated Care Clinic was founded – were given an appointment at either the Integrated Care Clinic or a conventional care clinic.
The 30-day mental health evaluation rate was 92 percent for the integrated care patients versus 59 percent for standard care patients. The rate for social work evaluation was 77 percent versus 56 percent.
For women veterans, the rate of initial mental health evaluations in integrated care was three times the conventional care rate. “This is good news, because women veterans have a high burden of mental health problems, and, at the same time, a disproportionate number of barriers to care, such as child care issues and other logistical constraints,” said Seal.
Researchers speculate another new treatment approach could encourage veterans to complete their course of PTSD treatment.
The strategy is called the VA Patient Aligned Care Team (PACT) model, a new team-based method of providing primary care in the VA system.
“One member of the patient care team could be assigned to make reminder phone calls ,for example, to encourage veterans to stick with and complete their mental health treatment,” Seal said.