Variation in Utilization of Health Care Services for Rural VA Enrollees With Mental Health‐Related Diagnoses

Johnson, Christopher; Bush, Ruth L.; Harman, Jeffrey S.; Bolin, Jane N.; Hudnall, Gina Evans; Nguyen, Ann M.

doi:10.1111/jrh.12105

Cited by 10 publications

(11 citation statements)

References 36 publications

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“…Andersen’s health behavioral model is the cornerstone of many studies assessing patient healthcare-seeking behavior and the accessibility of health services. The model has been used to improve healthcare services worldwide [11, 12, 23]. Our results demonstrated that there were significant demographic/pregnancy and environmental factor differences among pregnant women attending primary, secondary and tertiary hospitals.…”

Section: Discussionmentioning

confidence: 79%

Healthcare-seeking behavior among pregnant women in the Chinese hierarchical medical system: a cross-sectional study

Liu

Xue

Qian

et al. 2019

Int J Equity Health

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Background Hierarchical medical systems are common in developed countries, but it’s not optimistic in China. This study aimed to identify the factors affecting healthcare-seeking behavior among pregnant women in Guangdong, China. Methods We conducted a cross-sectional, observational survey, developed using the Andersen’s behavioral model. Pregnant women were randomly selected using a two-stage, stratified, random sampling method from hospitals in Guangdong, China. A multinomial logistic regression was used to identify statistically significant variables from aspect of environmental, demographic and pregnancy characteristics associated with pregnant women seeking healthcare at primary, secondary or tertiary hospitals. Results A total of 1393 pregnant women returned the survey after attending 1 of 12 hospitals within 4 cities of the Guangdong province: 537 (38.5%) of the respondents attended a primary hospital, 437 (31.4%) a secondary hospital, and 419 (30.1%) a tertiary hospital. Women attending primary hospitals were more likely to live closer to the hospital, live rurally, and be educated to a lower level. Several factors were significantly associated with attendance at a secondary vs a primary hospital: the woman’s perceived necessity to seek maternal healthcare (OR 1.73, 95% CI [1.1,2.74]), the woman’s choice of delivery hospital (OR 1.45, 95% CI [1.01,2.07]), or urban living (OR 1.39, 95% CI [1.03,1.88]). Characteristics associated with attendance at a tertiary vs a primary hospital were: a history of pregnancy complications (OR 2.35, 95% CI [1.43,3.86]), travel to the hospital by public transport/taxi (OR 2.09/2.67, 95% CI [1.35,3.22]/ [1.45,4.92]), urban living (OR 1.58, 95% CI [1.14,2.18]), or a planned current pregnancy (OR 1.53, 95% CI [1.07,2.19]). Conclusion Medical needs and convenience both play a role in the choice of hospital for antenatal care, and impact on equity utilization of health services. Pregnant women without risk factors and with higher levels of education should be a target population for guiding to choose a more proper level of hospital.

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Section: Discussionmentioning

confidence: 79%

Healthcare-seeking behavior among pregnant women in the Chinese hierarchical medical system: a cross-sectional study

Liu

Xue

Qian

et al. 2019

Int J Equity Health

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“…However, this study revealed having a mental health condition, including suicide attempts or self-harm, as a reason for emergent ED use. This association may be a reflection of access to mental healthcare, which has been shown to be hindered by distance to a provider, geography, and provider shortages, especially in rural areas [ 46 , 54 ]. Mental health patients potentially not having access to a primary-care provider or mental health specialist could result in not having the necessary resources available for regular treatment and, therefore, not seeking care until it is of emergent level in order to avoid costs they cannot afford.…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, the ‘any chronic disease/illness’ variable was recorded as ‘absence of a chronic disease/illness’. The ‘admission mental health’ variable equaled ‘presented due to mental health disease/illness’ if the admission diagnosis field contained an ICD-9 code for depression, anxiety, post-traumatic stress, schizophrenia, suicide, self-harm, or alcohol or substance abuse [ 5 , 21 , 26 , 46 ]. Otherwise the ‘admission mental health’ variable equaled ‘did not present due to mental health disease/illness’.…”

Section: Methodsmentioning

confidence: 99%

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

McManus

Cramer

Boshier

et al. 2018

IJERPH

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Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. ‘Other’ ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal ‘need’, including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

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“…In contrast to these reports, another study based on VHA data found that rural enrollees with mental health diagnoses were more likely than urban VA enrollees to have a mental health contact in an inpatient, office-based, or emergency room setting (Johnson et al, 2015) and a study of VHA service users who had served in Iraq found that rural veterans were more likely to receive diagnoses of PTSD and to receive treatment for PTSD and depression than their urban counterparts (Hudson et al, 2014). Finally, according to a national VHA analysis from 2014, while only 23.9% of all veterans live in rural areas, 32.9% of VA enrollees come from rural areas, suggesting that rural veterans are more likely to enroll in VHA services than urban veterans (Cowper Ripley et al, 2015).…”

mentioning

confidence: 95%

“…Military veterans are of particular concern in these areas because the all-volunteer U.S. military recruits more extensively from rural than urban areas, many veterans return home after their service, and suicide rates are elevated among veterans, as they are among non-veterans, in rural areas (Finn, 2006; Hammil, 2005; Kane, 2005; McCarthy et al, 2012). According to the Office of Rural Health of the Veterans Health Administration (VHA), 4.7 million veterans, about one-fourth of the total, live in non-urban areas (Office of Rural Health, 2019) and are thought to be at increased risk for mental health problems due to higher rates of poverty, greater distances to VHA facilities, reduced access to transportation, limited housing opportunities, and greater mental health stigma (Johnson et al, 2015; Office of Rural Health, 2019). Some studies suggest that even when rural veterans have similar or lower rates of mental health and substance use conditions, they report lower physical and mental health-related quality-of-life as compared to their urban counterparts (Wallace et al, 2006).…”

mentioning

confidence: 99%

Mental health service utilization in rural areas nationally in the Veterans Health Administration.

Bommersbach¹,

Stefanovics²,

Rosenheck³

2021

Journal of Rural Mental Health

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There has been increasing concern that rural Americans are at high risk for mental health problems but have limited access to mental health services. The Veterans Health Administration (VHA) is responsible for providing equitable care to all eligible veterans and thus offers a unique opportunity to identify systemic propensities for inequitable provision of specific mental health services in rural areas. This article compares the utilization of services in rural and urban areas nationally in the VHA. Zip codes from VHA administrative databases and rural-urban commuting area codes were used to classify all Fiscal Year 2012 VHA service users into those living in urban, large rural, small rural, and isolated rural communities. Because of large sample sizes, effect sizes (risk ratios and Cohen's d) rather than p values were used to identify substantial group differences in sociodemographic characteristics, diagnoses, and measures of service use (especially subtypes of mental health service use). The results demonstrate that of 5,252,056 VHA service users, 1,563,680 (29.8%) were from the three non-urban areas and altogether 1,332,001 (25.4%) used specialty mental health services. There were few substantial demographic or diagnostic differences between rural and urban veterans but notably veterans in rural areas were less likely to have substance use diagnoses and substantially less likely to receive subspecialty mental health services such as intensive case management, psychosocial rehabilitation, and homeless services. These results suggest that rural and urban VHA service users make similar use of mental health services overall but those disparities primarily affect sub-specialty mental health services. Public Health Significance StatementThis study demonstrates that rural and urban Veterans Health Administration (VHA) service users have similar mental health needs and utilize similar levels of mental health and substance use services overall. However, rural veterans are much less likely to receive subspecialty services, such as intensive case management, psychosocial rehabilitation, and homeless services, reflecting economic disincentive in small-scale rural programs, and drawing attention to the unique challenges of developing innovative service delivery models to expand access to specialty services in rural areas.

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Variation in Utilization of Health Care Services for Rural VA Enrollees With Mental Health‐Related Diagnoses

Abstract: Based on these variations, the VA may want to develop strategies to increase screening efforts in inpatient settings and emergency rooms to further capture rural VA enrollees who have undiagnosed mental health conditions.

Cited by 10 publications

References 36 publications

Healthcare-seeking behavior among pregnant women in the Chinese hierarchical medical system: a cross-sectional study

Healthcare-seeking behavior among pregnant women in the Chinese hierarchical medical system: a cross-sectional study

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Mental health service utilization in rural areas nationally in the Veterans Health Administration.

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