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Articles   |    
Veterans’ Perceptions of Behavioral Health Care in the Veterans Health Administration: A National Survey
Kimberly A. Hepner, Ph.D.; Susan M. Paddock, Ph.D.; Katherine E. Watkins, M.D., M.S.H.S.; Jacob Solomon, B.A.; Daniel M. Blonigen, Ph.D.; Harold Alan Pincus, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200385
View Author and Article Information

Dr. Hepner, Dr. Paddock, Dr. Watkins, Mr. Solomon, and Dr. Pincus are with the RAND Corporation, Santa Monica, California (e-mail: hepner@rand.org). Dr. Pincus is also with the Columbia University College of Physicians and Surgeons and New York–Presbyterian Hospital, New York City. Dr. Blonigen is with the Center for Health Care Evaluation, U.S. Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California. Portions of this article were presented at the Mental Health Services Research conference, Washington, D.C., July 27–28, 2011.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  This study provided national estimates of perceptions of behavioral health care services among patients of the Veterans Health Administration (VHA) with a diagnosis of bipolar I disorder, major depression, posttraumatic stress disorder, schizophrenia, or substance use disorder.

Methods  A stratified random sample of 6,190 patients completed telephone interviews from November 2008 through August 2009. Patients (N=5,185) who reported receiving VHA behavioral health care in the prior 12 months were asked about their need for housing and employment services, timeliness and recovery orientation of their care, satisfaction with care, and perceived improvement.

Results  Half of patients reported always receiving routine appointments as soon as requested, and 42% were highly satisfied with their VHA mental health care. Approximately 74% of patients reported being helped by the treatment they received, yet only 32% reported that their symptoms had improved. After controlling for covariates, the analyses showed that patients with a substance use disorder reported lower satisfaction with care and perceived their treatment to be less helpful compared with patients without a substance use disorder.

Conclusions  Although matched sample comparison data were not available, the results showed that overall patient perceptions of VHA mental health care were favorable, but there was significant room for improvement across all areas of assessment. A majority reported being helped by treatment, but few reported symptom improvement. Variations in perceptions among patients with different disorders suggest the potential importance of psychiatric diagnosis, particularly substance use disorder, in assessing patient perceptions of care.

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Table 1Characteristics of 5,185 patients who reported use of VHA behavioral health services in the previous 12 months
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a Percentages are weighted.

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b Includes Asian, Native Hawaiian or other Pacific Islander, American Indian/Alaskan Native, multiracial, none of these races, and refused or didn’t know

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c A mental or general medical condition that was incurred or aggravated during active duty

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d Measured by the Veterans RAND 12-Item Health Survey. Possible scores range from 0 to 100 for both mental health and physical health functioning, with higher scores indicating better functioning.

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e Among patients with at least one visit

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f Among patients with a stay of at least one night

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Table 2Perceptions of VHA behavioral health care among 5,185 patients, by diagnostic cohorta
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a All percentages are weighted.

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b Patients with a substance use disorder could also be assigned to one mental health diagnostic cohort.

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c Patients who tried to make appointments for counseling or treatment reported always receiving them as soon as requested.

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Table 3Perceived improvement in key areas among 5,185 patients who reported use of VHA behavioral health care, by diagnostic cohorta
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a All percentages are weighted.

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b Patients with a substance use disorder could also be assigned to one mental health diagnostic cohort.

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Table 4Association of patients’ perceptions of VHA behavioral health care and diagnostic cohorta
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a The analyses were adjusted for age, race, sex, service-connected disability, mental and physical health functioning, utilization (outpatient visits and inpatient nights), and co-occurring mental or substance use disorder.

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b Patients with bipolar I disorder are the reference group.

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c Patients without a substance use disorder are the reference group.

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Table 5Association of patients’ perceived improvement in key areas and diagnostic cohorta
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a The analyses were adjusted for age, race, sex, service-connected disability, mental and physical health functioning, utilization (outpatient visits and inpatient nights), and co-occurring mental or substance use disorder.

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b Patients with bipolar I disorder are the reference group.

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c Patients without a substance use disorder are the reference group.

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