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Access-related measures and out-of-system utilization among veterans with bipolar disorder
John F McCarthy1, Marcia Valenstein, Kara Zivin
1U.S. Department of Veterans Affairs National Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48113-0170, USA. john.mccarthy2@va.gov
Objective:
This study examined associations between access-related measures and out-of-system health services utilization (general medicine and mental health services) among patients with bipolar disorder at a U.S. Department of Veterans Affairs (VA) medical center.
Methods:
VA patients (N=391) with bipolar disorder answered questions about health services access (non-VA insurance coverage, travel distance to their VA facility, service-connected disability status, and difficulty receiving needed mental health care) and out-of-system services utilization. Multivariable Tobit regression was used to evaluate associations between access measures and propensity to receive out-of-system services.
Results:
More than half the veterans (56%) reported some non-VA utilization. Out-of-system utilization was more likely among patients who were married, younger, homeless, with private insurance, without service-connected disabilities, and who reported access difficulties.
Conclusions:
Out-of-system utilization was associated with multiple measures of access and indicators specific to VA and non-VA providers. Enhancing health system access for patients with bipolar disorder may reduce out-of-system utilization, potentially enhancing continuity of care.
