Date of Award

2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Prof-Technical & Technology Education

Abstract

High numbers of US Veterans experience post-traumatic stress disorder (PTSD), but, many do not subsequently seek mental healthcare. Integrated mental health (IMH) models of treatment bring mental health professionals into the primary care setting, allowing Veterans to receive comprehensive treatment during primary care visits. The IMH treatment model may bridge the gap for Veterans with PTSD who need care and those who actually receive it. This study examined the impact that IMH has on Veterans with PTSD receiving care from VA. Using several methods of data collection (medical chart reviews, VA administrative databases, a mailed survey of patient perception of patient-centered care (PCC)) the present quasi-experimental evaluation study examined a national sample of Veterans with PTSD, to evaluate the impact of IMH treatment (as compared to usual mental health care) on: physical health, mental health, PTSD, health services utilization, patient perceptions of key PCC constructs, provider recommendations for treatment, and considerations of patient preferences for treatment. Outcomes were compared for Veterans receiving IMH vs. usual mental health care; a multivariate logistic regression model was conducted to assess variables independently associated with IMH treatment receipt, and; mediation analyses examined whether the relationship between IMH treatment and receipt of ‘adequate’ mental health care is driven by patient perceptions of two important PCC constructs (patient activation; shared decision-making). Collectively, results indicate that IMH treatment receipt is associated with: increased outpatient and primary care visits; decreased psychotropic medication use; increased recommendations for complementary and alternative treatment modalities; more discussion of patient preferences for mental health treatment during more VA primary care and mental health encounters; better patient-reported physical health; greater patient activation, and; better patient perceptions of shared decision-making. Combining behavioral health care with traditional primary care through an integrative mental health treatment model may be most effective in increasing health care engagement, shared decision-making, and discussion of patient preferences for mental health care among Veterans with PTSD. Integrating mental health care providers into the primary care setting may be a good strategy for encouraging Veterans with PTSD to seek out and stay the course of the treatment they need.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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