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BACKGROUND/RATIONALE:
Among OEF/OIF veterans using the VA healthcare system, we have documented that depression and PTSD are the 2nd and 3rd most frequently diagnosed illnesses (pain is 1st). However, in a community-based sample of OEF/OIF veterans screening positive for PTSD, depression (DEP) or alcohol use disorders (AUD), less than half received mental health care. Rates of help seeking are likely to be even lower among rural OEF/OIF veterans. In fact, even though veterans living in rural areas have worse mental health status than veterans living in urban areas, they are less likely to be diagnosed with a mental health disorder by a VA provider. This finding is particularly troublesome because approximately 40% of veterans, including OEF/OIF veterans, live in rural areas. Although little is known about the impact of rural residence on access to care for OEF/OIF veterans, our previous research focusing on veterans from earlier periods of wartime service found that veterans who live farther from VA facilities have fewer VA mental health visits and are more likely to present in a crisis requiring psychiatric hospitalization.
OBJECTIVE(S):
1) Characterize the utilization of clinical services among OEF/OIF veterans who enroll in VISN 16 by comparing rural/urban differences in: a) attendance of first scheduled VA encounter, b) time to first VA encounter, c) clinic settings (CBOC or VAMC), d) clinic types (primary care, specialty physical or mental heath), and e) screening for PTSD, DEP and AUD.
2) Identify the impact of rural residence on detection, diagnosis, treatment, and continuity of care for PTSD, DEP or AUD.
3) Determine whether potential rural/urban differences in the detection, diagnosis, treatment and continuity of PTSD, DEP and AUD are mediated by travel distance or service setting (VAMC or CBOC).
METHODS:
Data from the OEF/OIF registry and the VISN 16 data warehouse will be used to identify veterans who were enrolled in VISN 16 since 9/11/01. Demographic, service use, alcohol use disorders, depression and PTSD screening, and pharmacy records will be extracted for the 6-months following the index dates for VA first encounter. Using the Rural Urban Commuting Area (RUCA) classification system veterans will be classified as living in rural or urban areas based on their residence zipcode of record. Objective 1: bivariate analyses (chi-square and t-tests) will be used to describe rural/urban differences in processes of care. Objective 2: Logistic regression and linear regression models will be used to compare rural/urban differences in screening, diagnosis, prescription of and adherence to psychotropic medications and counseling. Objective3: logistic regression models will be used to test whether travel time and service setting are moderating variables for rural/urban differences.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Anticipated Impact on Veterans Healthcare: Our proposed research will directly inform VA policy and will provide the preliminary evidence needed to develop outreach programs to improve access to mental health and substance use services for rural OEF/OIF veterans
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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