Mental health measurement among women veterans receiving co-located, collaborative care services

Abstract

Routine use of measurement to identify patient concerns and track treatment progress is critical to high quality patient care. This is particularly relevant to the Primary Care Behavioral Health model, where rapid symptom assessment and effective referral management are critical to sustaining population-based care. However, research suggests that women who receive treatment in co-located collaborative care settings utilizing the PCBH model are less likely to be assessed with standard measures than men in these settings. The current study utilized regional retrospective data obtained from the Veterans Health Administration’s electronic medical record system to: (1) explore rates of mental health measurement for women receiving co-located collaborative care services (N = 1008); and (2) to identify predictors of mental health measurement in women veterans in these settings. Overall, only 8% of women had documentation of standard mental health measures. Measurement was predicted by diagnosis, facility size, length of care episode and care setting. Specifically, women diagnosed with depression were less likely than those with anxiety disorders to have standard mental health measurement documented. Several suggestions are offered to increase the quality of mental health care for women through regular use of measurement in integrated care settings.

Keywords:

• Integrated care
• measurement-based care
• mental health
• women
• veterans

Acknowledgment

Portions of this study were presented at the 37th annual meeting of the Society of Behavioral Medicine in Washington, DC. The views expressed in this article are those of the authors and do not represent the position or policy of the Department of Veterans Affairs or the United States Government. The authors are full-time employees of the Department of Veterans Affairs.

Notes

1. Service connected disability is defined as a disability or impairment for an illness or injury which was incurred in or aggravated by military service. In the VHA, service connection entitles veterans to priority healthcare services (Veterans Benefits Administration, 2013).

2. Direct logistic regression models are used by entering all of the variables simultaneously into the equation, particularly when there are no specific hypotheses regarding the order or importance of the variables (Tabachnick & Fiddell, 2007, p. 454). Thus, covariates were not included in any of the direct logistic regression models. In addition, moderation was not tested in subsequent analyses given that we had no a priori hypotheses that the combined effects (i.e., interactions) of the variables would improve rates of mental health measurement.