| Autor: |
Miles SR; Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.; Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA., Sayer NA; Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.; Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis, USA., Belanger HG; Department of Psychology, University of South Florida, Tampa, Florida, USA.; United States Special Operations Command, St. Michael's Inc.; Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA., Venkatachalam HH; Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA., Kozel FA; Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida State University, Tallahassee, Florida, USA., Toyinbo PA; Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA.; College of Public Health, University of South Florida, Tampa, Florida, USA., McCart JA; Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA.; College of Medicine, University of South Florida, Tampa, Florida, USA., Luther SL; Research and Development Service, James A. Haley Veterans' Hospital, Tampa, Florida, USA.; College of Public Health, University of South Florida, Tampa, Florida, USA. |
| Abstrakt: |
The Veterans Health Administration (VHA) screens veterans who deployed in support of the wars in Afghanistan and Iraq for traumatic brain injury (TBI) and mental health (MH) disorders. Chronic symptoms after mild TBI overlap with MH symptoms, for which there are already established screens within the VHA. It is unclear whether the TBI screen facilitates treatment for appropriate specialty care over and beyond the MH screens. Our primary objective was to determine whether TBI screening is associated with different types (MH, Physical Medicine & Rehabilitation [PM&R], and Neurology) and frequency of specialty services compared with the MH screens. A retrospective cohort design examined veterans receiving VHA care who were screened for both TBI and MH disorders between Fiscal Year (FY) 2007 and FY 2018 (N = 241,136). We calculated service utilization counts in MH, PM&R, and Neurology in the six months after the screens. Zero-inflated negative binomial regression models of encounters (counts) were fit separately by specialty care type and for a total count of specialty services. We found that screening positive for TBI resulted in 2.38 times more specialty service encounters than screening negative for TBI. Compared with screening positive for MH only, screening positive for both MH and TBI resulted in 1.78 times more specialty service encounters and 1.33 times more MH encounters. The TBI screen appears to increase use of MH, PM&R, and Neurology services for veterans with post-deployment health concerns, even in those also identified as having a possible MH disorder. |
