1042. Treatment Retention Among VA Patients with Psychoses: Health System Factors
John F McCarthy, PhD, Center for Practice Management and Outcomes Research, SMITREC, VA Ann Arbor Healthcare System, KL Barry, Center for Practice Management and Outcomes Research, SMITREC, VA Ann Arbor Healthcare System, FC Blow, Center for Practice Management and Outcomes Research, SMITREC, VA Ann Arbor Healthcare System, EP Fischer, Central Arkansas Veterans Healthcare System, CeMHOR, T Hudson, Central Arkansas Veterans Healthcare System, CeMHOR, RV Ignacio, Center for Practice Management and Outcomes Research, SMITREC, VA Ann Arbor Healthcare System, RR Owen, Central Arkansas Veterans Healthcare System, CeMHOR, M Valenstein, Center for Practice Management and Outcomes Research, SMITREC, VA Ann Arbor Healthcare System

Objectives: Despite high morbidity and ongoing treatment needs, patients with psychoses are difficult to retain in care. This study evaluated the influence of geographic accessibility and VA and non-VA service availability on retention, adjusting for patient characteristics.

Methods: Among 125,286 patients with schizophrenia or bipolar disorder in FY98, survival analysis was used to model time to first 12-month gap in VA care over three years, FY99-FY01. Covariates included age, gender, race/ethnicity, marital status, psychosis type, Charlson comorbidity, last treatment location in FY98, and days since last VA care (at end of FY98). Geographic accessibility was operationalized as straight-line distance to nearest VA medical center. Service availability was assessed using county-level VA hospital beds and non-VA beds, per 1000 residents. Patients who died before gaps were censored.

Results: Over three years, 7585 patients (6%) had a 12-month gap in VA care. Individuals who were younger, male, non-white, unmarried, had bipolar disorder, low medical morbidity, an inpatient psychiatric treatment location, or resided farther from VAMCs were more likely to drop out of care. Greater VA bed availability improved retention, while non-VA availability was not significant.

Conclusions: Among VA patients with psychoses, patient predisposing and need characteristics strongly predict retention in care. Distance increases risks of substantial gaps in treatment. VA service availability improves retention, however retention may not be sensitive to the availability of non-VA providers.

Impact: Geographic barriers remain a challenge for treatment retention. Moreover, when patients with psychoses fall out of care, non-VA services may not substitute for VA care.