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Use of VA Facility and VA-Purchased Behavioral Health Services Among Post-9/11 Veterans With and Without Traumatic
Diana J Govier1, Elizabeth R Hooker, Sarah Shull
1Author Affiliations: Veterans Rural Health Resource Center-Portland (Govier), VHA Office of Rural Health, Portland, Oregon; Center to Improve Veteran Involvement in Care (Govier, Hooker, Shull, Kelly, Gilbert, O'Neil, Hynes, and Carlson), VA Portland Health Care System, Portland, Oregon; Oregon Health and Science University-Portland State University School of Public Health (Govier, Hooker, Kelly, and Carlson), Portland, Oregon; Center for Health Optimization and Implementation Research (Pogoda and Zogas), VA Boston Healthcare System, Boston, Massachusetts; Boston University School of Public Health (Pogoda), Boston, Massachusetts; Boston University Chobanian and Avedisian School of Medicine (Zogas), Boston, Massachusetts; Department of Psychiatry (O'Neil), Oregon Health & Science University, Portland, Oregon; Department of Medicine (O'Neil), Oregon Health & Science University, Portland, Oregon; VISN 20 VA Northwest Mental Illness Research, Education, and Clinical Center (O'Neil), Portland, Oregon; Informatics (Pugh), VA Salt Lake City Health Care System, Salt Lake City, Utah; Department of Medicine (Pugh), Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah; School of Nursing (Hynes), Oregon Health and Science University, Portland, Oregon; and College of Health and Center for Quantitative Life Sciences (Hynes), Oregon State University, Corvallis, Oregon.
Objective:
Behavioral health conditions are prevalent among post-9/11-era veterans with traumatic brain injury (TBI); however, little contemporary data exist on their behavioral health services use. We examined outpatient, emergency department (ED), and urgent care behavioral health services use in VA facilities and VA-purchased community care (VACC) among post-9/11 era veterans with and without clinician-confirmed TBI.
Setting:
Nationwide VA facility and VACC, 2021 through 2022.
Participants:
1,374,771 veterans who were screened for deployment-related TBI and, where indicated, completed VA Comprehensive TBI Evaluation.
Design:
Retrospective, observational study.
Main Measures:
VA facility reliance, measured as the percentage of VA facility and VACC behavioral health services that were delivered in VA facilities. Multivariable fractional logistic regression was used to estimate VA facility reliance by TBI history/severity and behavioral health service type (outpatient, ED, urgent care); models were adjusted for sociodemographic, military history, and clinical variables. VACC and VA facility behavioral health visits and diagnoses were examined by TBI history/severity.
Results:
Among veterans screened for deployment-related TBI, 4.1% had a history of mild TBI and 0.6% moderate/severe TBI. Overall, 49.6% used behavioral health services during 2021 through 2022. There were differences in service use based on TBI history/severity and setting of use. Compared with veterans without TBI, greater percentages of veterans with mild or moderate/severe TBI used outpatient behavioral health services (48.7% vs. 63.3% and 68.6%, respectively). However, more than one-third of veterans with TBI did not use any of the behavioral health services we examined. In adjusted regression models, for each TBI history/severity group, VA facility reliance was the highest for outpatient behavioral health services (94.7%-95.0%) and the lowest for ED behavioral health services (65.9%-69.3%). Among veterans with moderate/severe TBI, 8 in every 10 VACC behavioral health services were for posttraumatic stress or substance use disorder.
Conclusions:
Findings suggest that further attention to the behavioral health needs of post-9/11 era veterans is warranted and offer targets for monitoring VACC behavioral health care quality.
