Quality of Preventive Medical Care for Patients With Mental Disorders

Abstract

BACKGROUND/OBJECTIVES: This study compares quality of preventive services between persons with and without mental/substance use disorders for a national sample of medical outpatients. RESEARCH DESIGN: Cross-sectional study. SUBJECTS: A total of 113,505 veterans with chronic conditions and at least three general medical visits to Veterans Health Administration medical providers during 1998 to 1999. MEASURES: Chart-derived rates of eight preventive services: two measures of immunization, four measures of cancer screening, and two of tobacco screening and counseling. Multivariable-generalized estimating equations compared rates of each preventive service among veterans with psychiatric disorders, substance use disorders, both, and neither, adjusting for demographic, health status, and facility-level characteristics. RESULTS: On average, persons in the sample obtained 64% of the eight preventive procedures for which they were eligible. Overall rates of currency with preventive services were 58% for patients with combined psychiatric/substance use disorders, 60% and 65% for those with psychiatric and substance use disorders alone, and 66% for those with neither psychiatric nor substance use disorders. Each difference remained statistically significant in multivariable models. CONCLUSIONS: In this sample of patients in active medical treatment, rates of preventive services were higher than rates reported for population-based, private-sector samples. Despite these high-baseline rates, persons with psychiatric disorders, particularly with comorbid substance use, were at risk for lower rate of receipt of preventive services.