Skip to main content

Advertisement

SpringerLink
Log in

Healthcare Utilization and Symptom Variation Among Veterans Using Behavioral Telehealth Center Services

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

Substance use and mental health problems are often underdiagnosed and undertreated in primary care. Veterans affairs facilities are using the Behavioral Telehealth Center (BTC) to provide evidence-based assessments for primary care patients via telephone. Whether participation in BTC services is associated with (1) increases in healthcare utilization and (2) decreases in symptoms based on behavioral health screening instruments, post-BTC services compared with pre-BTC services were investigated. Retrospective data were extracted for 1,820 patients who were referred to the BTC. Differences in utilization rates and symptom scores pre- and post-BTC services were tested using repeated measures analysis of covariance while controlling for relevant sociodemographic variables. Participants (1) utilized significantly more substance use and mental health treatment services and (2) had significantly lower alcohol and depression screening scores post-BTC services compared with pre-BTC services. This initial evaluation provides support that BTC services are associated with increased healthcare utilization and decreased alcohol and depressive symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Toft T, Fink P, Oernboel E, et al. Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary care (FIP) study. Psychological Medicine 2005; 35: 1175–1184.

    Article  PubMed  Google Scholar 

  2. National Ambulatory Medical Survey 2008 Survey Tables; Center for Disease Control, Mental Health Work Group, Atlanta, Ga. 30341–3717.

  3. Spoont M, Murdoch M, Hodges J, et al. Treatment receipt by veterans after a PTSD diagnosis in PTSD, mental health, or general medical clinics. Psychiatric Services 2010; 61: 58–63.

    Article  PubMed  Google Scholar 

  4. Gillock KL, Zayfert C, Hegel MT, et al. PTSD in primary care: prevalence and relationships with physical symptoms and medical utilization. General Hospital Psychiatry 2005; 27: 392–399.

    Article  PubMed  Google Scholar 

  5. Murray C, Lopez A. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Boston: Harvard University Press, 1996.

    Google Scholar 

  6. Rauch SAM, Morales KH, Zubritsky C, et al.. Posttraumatic stress, depression and health among older adults in primary care. American Journal Geriatric Psychiatry 2006; 14: 316–324.

    Article  Google Scholar 

  7. Schulberg H, Block M, Madonia M, et al. The ‘usual care’ of major depression in primary care practice. Archives of Family Medicine 1997; 6: 334–339.

    Article  PubMed  CAS  Google Scholar 

  8. Wells K, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care, a randomized controlled trial. Journal of the American Medical Association 2000; 283: 212–220.

    Article  PubMed  CAS  Google Scholar 

  9. Oslin DW, Ross J, Sayers S, et al. Screening, assessment, and management of depression in VA primary care clinics: the behavioral health laboratory. Journal of General Internal Medicine 2006; 21: 46–50.

    Article  PubMed  Google Scholar 

  10. Bush K, Kiylahan DR, McDonnell MB, et al.. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test of problem drinking. Archives of General Internal Medicine 1998; 158: 1789–1795.

    Article  CAS  Google Scholar 

  11. Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Medical Care 2003; 11: 1284–1292.

    Article  Google Scholar 

  12. Prins A, Ouimette P, Kimerling R, et al. The primary care PTSD screen (PC-PTSD): development and operating characteristics. Primary Care Psychiatry 2003; 9: 9–14.

    Article  Google Scholar 

  13. Kroenke KR, Spitzer L, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 2001; 16: 606–613.

    Article  PubMed  CAS  Google Scholar 

  14. Weathers F, Ford J. Psychometric review of the PTSD Checklist. In: Stamm B, editor. Measurement of stress, trauma, and adaptation. Lutherville, MD: Sidran Press, 1996. pp. 250–251.

    Google Scholar 

  15. PTSD Checklist (PCL). National Center for PTSD. Available at: http://www.ptsd.va.gov/professional/pages/assessments/ptsd-checklist.asp. Accessed 20 December 2011.

  16. Sheehan DV, Lecrubier K, Sheehan P, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 1998; 59: 22–33.

    PubMed  Google Scholar 

  17. National Institute on Alcoholism and Alcohol Abuse. Helping Patients Who Drink Too Much, A Clinician’s Guide: Updated 2005 Edition (NIH Publication No. 07–3769). Washington, DC: Government Printing Office. 2007.

    Google Scholar 

  18. Paykel ES, Myers JK, Lindenthal JJ, et al. Suicidal feelings in the general population: a prevalence study. British Journal of Psychiatry 1974; 124: 460–469.

    Article  PubMed  CAS  Google Scholar 

  19. Ware JE, Kosinski M, Turner-Bowker DM, et al. How to Score Version 2 of the SF-12 Health Survey. Lincoln, RI: Quality Metric Incorporated. 2002.

    Google Scholar 

  20. Elhai, JD, Richardson, JD, Pedlar, DJ. Predictors of general medical and psychological treatment use among a national sample of peacekeeping veterans with health problems. Journal of Anxiety Disorders 2007; 21: 580–589.

    Article  PubMed  Google Scholar 

  21. Frueh, BC, Grubaugh, AL, Acierno, R, et al. Age difference in Post-traumatic stress disorder, psychiatric disorders, and health care service use among veterans in Veterans Affairs primary care clinics. American Journal of Geriatric Psychiatry 2007; 15: 660–672.

    PubMed  Google Scholar 

  22. Alegría M, Canino G, Ríos R, et al. Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatric Services 2007; 15:1547–1555.

    Google Scholar 

  23. Gary FA. Stigma: barrier to mental healthcare among ethnic minorities. Issues in Mental Health Nursing 2005; 26:979–999.

    Article  PubMed  Google Scholar 

  24. Veterans Affairs/Department of Defense (VA/DoD). Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) in primary care. In: VA/DOD clinical practice guideline for the management of post-traumatic stress (Module B). 2004. Available at: http://www.healthquality.va.gov/ptsd/ptsd_full.pdf

  25. Magruder KM, Frueh BC, Knapp RG, et al. Prevalence of posttraumatic stress disorder in veterans affairs primary care clinics. General Hospital Psychiatry 2005; 27: 167–179.

    Article  Google Scholar 

  26. Kessler RC, Sonegga A, Bromet E, et al. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 1995; 52: 1048–1060

    Article  PubMed  CAS  Google Scholar 

  27. Hankin CS, Spiro A, Miller DR, et al. Mental disorders and mental health treatment among U.S. Department of veterans affairs outpatients: the veterans health study. American Journal of Psychiatry 1999; 156: 1924–1930.

    PubMed  CAS  Google Scholar 

  28. Backenstrass M, Frank A, Joest K, et al. A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care. Comprehensive Psychiatry 2006; 47: 35–41.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest Statement

The authors do not have financial or any other conflicts of interest regarding the contents of this manuscript.

Author information

Authors and Affiliations

  1. Syracuse Veterans Affairs Medical, Center for Integrated Healthcare, 800 Irving Avenue-116C, Syracuse, NY, 13210, USA

    Kyle Possemato PhD, Todd M. Bishop MS, Matthew A. Willis MA & Larry J. Lantinga PhD

  2. Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA

    Kyle Possemato PhD, Todd M. Bishop MS & Larry J. Lantinga PhD

  3. School for Information Studies, Syracuse University, 343 Hinds Hall, Syracuse, NY, 13244, USA

    Matthew A. Willis MA

  4. VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave (116C), Syracuse, NY, 13210, USA

    Kyle Possemato PhD

Authors
  1. Kyle Possemato PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Todd M. Bishop MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew A. Willis MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Larry J. Lantinga PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyle Possemato PhD.

Additional information

This material is the result of work supported with resources and the use of facilities at the Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY. The contents do not represent the views of the Department of Veterans Affairs or the US Government.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Possemato, K., Bishop, T.M., Willis, M.A. et al. Healthcare Utilization and Symptom Variation Among Veterans Using Behavioral Telehealth Center Services. J Behav Health Serv Res 40, 416–426 (2013). https://doi.org/10.1007/s11414-013-9338-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-013-9338-y

Keywords

Search

Navigation