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Changing Patterns of Mental Health Care Use: The Role of Integrated Mental Health Services in Veteran Affairs Primary Care
Open accessAbstract
OBJECTIVE: Aiming to foster timely, high-quality mental health care for Veterans, VA's Primary Care-Mental Health Integration (PC-MHI) embeds mental health specialists in primary care and promotes care management for depression. PC-MHI and patient-centered medical home providers work together to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions. This study examines whether increasing primary care clinic engagement in PC-MHI services is associated with changes in patient health care utilization and costs. METHODS: We performed a retrospective longitudinal cohort study of primary care patients with identified mental health needs in 29 Southern California VA clinics from October 1, 2008 to September 30, 2013, using electronic administrative data (n = 66,638). We calculated clinic PC-MHI engagement as the proportion of patients receiving PC-MHI services among all primary care clinic patients in each year. Capitalizing on variation in PC-MHI engagement across clinics, our multivariable regression models predicted annual patient use of 1) non-primary care based mental health specialty (MHS) visits, 2) total mental health visits (ie, the sum of MHS and PC-MHI visits), and 3) health care utilization and costs. We controlled for year- and clinic-fixed effects, other clinic interventions, and patient characteristics. RESULTS: = .002); this is a substitution rate, at the mean, of 1.5 PC-MHI visits for each MHS visit. There was no PC-MHI effect on other health care utilization and costs. CONCLUSIONS: As intended, greater clinic engagement in PC-MHI services seems to increase realized accessibility to mental health care for primary care patients, substituting PC-MHI for MHS visits, without increasing acute care use or total costs. Thus, PC-MHI services within primary care clinics may improve mental health care value at the patient population level. More research is needed to understand the relationship between clinic PC-MHI engagement and clinical quality of mental health care.
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IPC has significantly improved access to mental health care in primary care, particularly for pharmacological treatment of anxiety.
“IPC has significantly improved access to mental health care in primary care (Leung et al., 2018), particularly for pharmacological treatment of anxiety.”
From Barriers to and Facilitators of Using Evidence-Based, Cognitive–Behavioral Anxiety Interventions in Integrated Primary Care Practice (2023) · cites this paper as Leung et al., 2018
The Adjusted Analyses report significantly more total mental health visits at clinics with higher PC-MHI engagement, and the Discussion says this seems to improve access for primary care patients. The study reports an association and hedges its access conclusion, so the unqualified claim that integration improved access is stronger than the source supports. The anxiety-treatment phrase follows the citation and is not assessed as a claim attributed to Leung et al. (LLM, conf=0.82)
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Metadata
- Authors
- Leung, L. B., Yoon, J., Rubenstein, L. V., Post, E. P., Metzger, M. E., Wells, K. B., Sugar, C. A., & Escarce, J. J.
- Affiliations
- RAND Corporation (US)
- ORCID
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2018-01
- Volume
- 31
- Issue
- 1
- Pages
- 38-48
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2783100652
- Cited by
- 36
- References
- 27
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 6 · 2021: 5 · 2020: 5 · 2019: 6 · 2018: 4
- FWCI
- 6.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Robert Wood Johnson Foundation
- Quality Enhancement Research Initiative
- National Institute of Environmental Health Sciences (P50ES012383)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Keywords
- primary care mental health integration, integrated mental health services, veterans, mental health service utilization, mental health care costs, primary health centers, care management, depression, patient-centered medical home, health care access
- MeSH terms
- Adult, Aged, Aged, 80 and over, Mental Disorders, California, Female, Humans, Longitudinal Studies, Male, Mental Health, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Primary Health Care, Retrospective Studies, United States, United States Department of Veterans Affairs, Delivery of Health Care, Integrated, Veterans Health
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