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Randomized Controlled Trial
. 2009 Mar;24(3):305-11.
doi: 10.1007/s11606-008-0867-7. Epub 2008 Dec 20.

Dual use of VA and non-VA services among primary care patients with depression

Chuan-Fen Liu  1 , Cory Bolkan, Domin Chan, Elizabeth M Yano, Lisa V Rubenstein, Edmund F Chaney
Affiliations
Randomized Controlled Trial

Dual use of VA and non-VA services among primary care patients with depression

Chuan-Fen Liu et al. J Gen Intern Med. 2009 Mar.

Abstract

Background: Depression treatment requires close monitoring to achieve optimal, long-term control. Use of multiple sources of health care can affect coordination and continuity of treatment for depression.

Objectives: To assess levels of non-Veterans Health Administration (VA) use among depressed primary care patients by service type and examine patient factors associated with non-VA use.

Design: Cross-sectional comparison of dual and VA-only users among depressed primary care patients. Depression was defined as PHQ-9 >or=10.

Subjects: Five hundred fifty depressed patients from the baseline sample of a group-randomized trial of collaborative care for depression in ten VA primary care practices.

Measurements: VA and non-VA outpatient utilization for physical and emotional health problems in the prior 6 months, patient demographics, and co-morbid conditions. All measures were self-reported and obtained at the baseline interview.

Results: Overall, 46.8% of VA depressed primary care patients utilized non-VA care. Dual users were more likely to use acute care services (emergency room or inpatient), especially for physical health problems. Dual users of physical health services had more total visits, but fewer VA visits than VA-only users, while dual users of emotional health services had fewer total and VA visits. Factors associated with dual use were urban clinic location, having other insurance coverage, and dissatisfaction with physical health care in general.

Conclusions: Almost half of depressed primary care patients used non-VA care, with most of their non-VA use for physical rather than emotional health problems. Care management strategies for depressed patients should include communication and coordination with non-VA providers.

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Figures

Figure 1
Figure 1
Sampling flow chart.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1046/j.1525-1497.1999.00335.x', 'is_inner': False, 'url': 'https://doi.org/10.1046/j.1525-1497.1999.00335.x'}, {'type': 'PMC', 'value': 'PMC1496577', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1496577/'}, {'type': 'PubMed', 'value': '10337036', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10337036/'}]}
    2. Borowsky SJ, Cowper DC. Dual use of VA and non-VA primary care. J Gen Intern Med. 1999;14:274–80. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1097/01.mlr.0000244657.90074.b7', 'is_inner': False, 'url': 'https://doi.org/10.1097/01.mlr.0000244657.90074.b7'}, {'type': 'PubMed', 'value': '17304078', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/17304078/'}]}
    2. Hynes DM, Koelling K, Stroupe K, et al. Veterans’ access to and use of Medicare and Veterans Affairs health care. Med Care. 2007;45:214–23. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '18388846', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/18388846/'}]}
    2. Ross JS, Keyhani S, Keenan PS, et al. Dual use of Veterans Affairs services and use of recommended ambulatory care. Med Care. 2008;46:309–16. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1177/1077558703060002007', 'is_inner': False, 'url': 'https://doi.org/10.1177/1077558703060002007'}, {'type': 'PubMed', 'value': '12800686', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12800686/'}]}
    2. Shen Y, Hendricks A, Zhang S, Kazis LE. VHA enrollees’ health care coverage and use of care. Med Care Res Rev. 2003;60:253–67. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC1070156', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1070156/'}, {'type': 'PubMed', 'value': '9018214', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9018214/'}]}
    2. Wright SM, Daley J, Fisher ES, Thibault GE. Where do elderly veterans obtain care for acute myocardial infarction: Department of Veterans Affairs or Medicare? Health Serv Res. 1997;31:739–54. - PMC - PubMed

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