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Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers

dc.contributor.authorMcCarthy, John F.en_US
dc.contributor.authorBlow, Frederic C.en_US
dc.contributor.authorValenstein, Marciaen_US
dc.contributor.authorFischer, Ellen P.en_US
dc.contributor.authorOwen, Richard R.en_US
dc.contributor.authorBarry, Kristen Lawtonen_US
dc.contributor.authorHudson, Teresa J.en_US
dc.contributor.authorIgnacio, Rosalinda V.en_US
dc.date.accessioned2010-06-01T20:18:56Z
dc.date.available2010-06-01T20:18:56Z
dc.date.issued2007-06en_US
dc.identifier.citationMcCarthy, John F.; Blow, Frederic C.; Valenstein, Marcia; Fischer, Ellen P.; Owen, Richard R.; Barry, Kristen L.; Hudson, Teresa J.; Ignacio, Rosalinda V. (2007). "Veterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriers." Health Services Research 42(3p1): 1042-1060. <http://hdl.handle.net/2027.42/73433>en_US
dc.identifier.issn0017-9124en_US
dc.identifier.issn1475-6773en_US
dc.identifier.urihttps://hdl.handle.net/2027.42/73433
dc.identifier.urihttp://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=17489903&dopt=citationen_US
dc.description.abstractWe examine the impact of two dimensions of access—geographic accessibility and availability—on VA health system and mental health treatment retention among patients with serious mental illness (SMI). Methods . Among 156,631 patients in the Veterans Affairs (VA) health care system with schizophrenia or bipolar disorder in fiscal year 1998 (FY98), we used Cox proportional hazards regression to model time to first 12-month gap in health system utilization, and in mental health services utilization, by the end of FY02. Geographic accessibility was operationalized as straight-line distance to nearest VA service site or VA psychiatric service site, respectively. Service availability was assessed using county-level VA hospital beds and non-VA beds per 1,000 county residents. Patients who died without a prior gap in care were censored. Results . There were 32, 943 patients (21 percent) with a 12-month gap in health system utilization; 65,386 (42 percent) had a 12-month gap in mental health services utilization. Gaps in VA health system utilization were more likely if patients were younger, nonwhite, unmarried, homeless, nonservice-connected, if they had bipolar disorder, less medical morbidity, an inpatient stay in FY98, or if they lived farther from care or in a county with fewer VA inpatient beds. Similar relationships were observed for mental health, however being older, female, and having greater morbidity were associated with increased risks of gaps, and number of VA beds was not significant. Conclusions . Geographic accessibility and resource availability measures were associated with long-term continuity of care among patients with SMI. Increased distance from providers was associated with greater risks of 12-month gaps in health system and mental health services utilization. Lower VA inpatient bed availability was associated with increased risks of gaps in health system utilization. Study findings may inform efforts to improve treatment retention.en_US
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dc.format.extent3109 bytes
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dc.publisherBlackwell Publishing Incen_US
dc.rights© 2006 Health Research and Educational Trusten_US
dc.subject.otherAccess/Demand/Utilization of Servicesen_US
dc.subject.otherMental Healthen_US
dc.subject.otherVA Health Systemen_US
dc.titleVeterans Affairs Health System and Mental Health Treatment Retention among Patients with Serious Mental Illness: Evaluating Accessibility and Availability Barriersen_US
dc.typeArticleen_US
dc.subject.hlbsecondlevelPublic Healthen_US
dc.subject.hlbtoplevelHealth Sciencesen_US
dc.description.peerreviewedPeer Revieweden_US
dc.contributor.affiliationumDepartment of Psychiatry, University of Michigan, Ann Arbor, MI, HSR&D Field Program/SMITREC, P.O. Box 130170, Ann Arbor, MI 48113-0170 ,en_US
dc.contributor.affiliationumDepartment of Psychiatry, University of Michigan, Ann Arbor, MI ,en_US
dc.contributor.affiliationotherDepartment of Veterans Affairs, Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor, MI ,en_US
dc.contributor.affiliationotherDepartment of Veterans Affairs HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR ,en_US
dc.contributor.affiliationotherCenters for Mental Healthcare Research, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, ARen_US
dc.identifier.pmid17489903en_US
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/73433/1/j.1475-6773.2006.00642.x.pdf
dc.identifier.doi10.1111/j.1475-6773.2006.00642.xen_US
dc.identifier.sourceHealth Services Researchen_US
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dc.owningcollnameInterdisciplinary and Peer-Reviewed


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