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Dual Use of VA and Non-VA Services Among Primary Care Patients with Depression

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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 ≥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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Acknowledgements

This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development (HSR&D) Service, grant MHI 99-375.

Drs. Liu, Balkan, and Chaney are at the Northwest Center for Outcomes Research in Older Adults at the Seattle VA. Drs. Rubenstein and Yano are presently at the Center for the Study for Healthcare Provider Behavior at Greater Los Angeles VA. Dr. Chan is at the Department of Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, or the US government, or other affiliated institutions.

Conflict of Interest

None disclosed.

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Correspondence to Chuan-Fen Liu PhD.

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Liu, CF., Bolkan, C., Chan, D. et al. Dual Use of VA and Non-VA Services Among Primary Care Patients with Depression. J GEN INTERN MED 24, 305–311 (2009). https://doi.org/10.1007/s11606-008-0867-7

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  • DOI: https://doi.org/10.1007/s11606-008-0867-7

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