Comparative risks of all-cause mortality for Veterans with schizophrenia with ongoing receipt of clozapine and other antipsychotic medications.

To guide care for patients with schizophrenia, the Veterans Health Administration (VHA) evaluated the associations between current or recent use of clozapine and all-cause mortality and explored associations for other antipsychotic medications. Using a case-control design, patients with schizophrenia who died in fiscal years 2014-2018 were matched on age, sex, race, and VHA facility to up to 10 controls who were alive on the case's date of death (index date). Medication coverage during the 91 days before the index date was classified as none, partial (1-44 days), and consistent (45-91 days).

Facility-Level Excess Mortality of VHA Patients With Mental Health or Substance Use Disorder Diagnoses.

Objective: Individuals with mental or substance use disorders have higher mortality rates than people in the general population. How excess mortality varies across health care facilities is unknown. The authors sought to investigate facility-level mortality rates among Veterans Health Administration (VHA) patients who had received diagnoses of mental or substance use disorders.

Increased Risk of Dementia Among Veterans With Bipolar Disorder or Schizophrenia Receiving Care in the VA Health System.

Objective: The Veterans Health Administration (VHA) provides a continuum of care over the life course. Among U.S.

Use of feedback to improve mental number line representations in primary care clinics.

Background: As patients become more engaged in decisions regarding their medical care, they must weigh the potential benefits and harms of different treatments. Patients who are low in numeracy may be at a disadvantage when making these decisions, as low numeracy is correlated with less precise representations of numerical magnitude. The current study looks at the feasibility of improving number representations.

Utilization of Continuous "Spinners" to Communicate Risk.

Background: As patients become more involved in their medical care, they must consider the specific probabilities of both positive and negative outcomes associated with different treatments. Patients who are low in numeracy may be at a disadvantage when making these decisions. This study examined the use of a "spinner" to present probabilistic information compared to a numerical format and icon array.

Integrated care: treatment initiation following positive depression screens.

Background: Primary Care-Mental Health Integration (PC-MHI) may improve mental health services access and continuity of care.

Objective: To assess whether receipt of integrated PC-MHI services on the date of an initial positive depression screen influences receipt of depression treatment among primary care (PC) patients in the Veterans Health Administration.

Design: Retrospective cohort study.

VA primary care-mental health integration: patient characteristics and receipt of mental health services, 2008-2010.

Objective: In 2007, the U.S. Department of Veterans Affairs (VA) health system began nationwide implementation of primary care-mental health integration (PC-MHI) programs to enhance mental health access and promote treatment of common mental health conditions for patients in primary care settings.

Primary care-mental health integration programs in the veterans affairs health system serve a different patient population than specialty mental health clinics.

Objective: To assess whether Primary Care-Mental Health Integration (PC-MHI) programs within the Veterans Affairs (VA) health system provide services to patient subgroups that may be underrepresented in specialty mental health care, including older patients and women, and to explore whether PC-MHI served individuals with less severe mental health disorders compared to specialty mental health clinics.

Method: Data were obtained from the VA National Patient Care Database for a random sample of VA patients, and primary care patients with an ICD-9-CM mental health diagnosis (N = 243,806) in 2009 were identified. Demographic and clinical characteristics between patients who received mental health treatment exclusively in a specialty mental health clinic (n = 128,248) or exclusively in a PC-MHI setting (n = 8,485) were then compared.

Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care-Mental Health Integration services.

Objective: For patients with an initial primary care (PC) encounter in the Veterans Health Administration (VHA) that included a mental health diagnosis, we evaluate whether same-day receipt of Primary Care-Mental Health Integration (PC-MHI) services is associated with the likelihood of receiving a subsequent mental-health-related encounter in the following 90 days.

Method: Using VHA administrative data, we identified 9046 patients who received VHA care for the first time in fiscal year 2009, received a PC encounter that included a mental health diagnosis on the first day of their VHA services and initiated care at a VHA facility that provided PC-MHI services. Using multivariable generalized estimating equations logistic regression, we examined whether receipt of same-day PC-MHI was associated with receipt of a subsequent encounter with a mental health diagnosis within 90 days.

Implementation of primary care-mental health integration services in the Veterans Health Administration: program activity and associations with engagement in specialty mental health services.

This paper describes the status of the Veterans Health Administration (VHA) Primary Care-Mental Health Integration (PC-MHI) services implementation and presents an assessment of associations between receipt of PC-MHI services and likelihood of receiving a second specialty mental health (SMH) appointment following an initial SMH encounter. The total PC-MHI service recipients and encounters/month rose substantially between October 2007 and April 2011. Adjusting for important covariates, the likelihood of receiving a second SMH encounter within 3 months of an index SMH appointment was 1.

Trends in antidepressant prescribing for new episodes of depression and implications for health system quality measures.

Background: The nationally reported Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management measure assesses whether patients with new episodes of depression receive antidepressant coverage for 84 of the first 114 days of treatment. Although initial prescriptions for a 90-day supply satisfy measure requirements, they may circumvent its purpose of ensuring adequate medication management.

Objectives: To assess the extent to which 90-day initial prescriptions have contributed to health system performance on the HEDIS antidepressant measure from fiscal years 2001 to 2008.

Are primary care mental health services associated with differences in specialty mental health clinic use?

Objectives: The aim of this study was to determine whether implementation of primary care mental health services is associated with differences in specialty mental health clinic use within the Veterans Health Administration (VHA).

Methods: The authors compared over a one-year period the new use of specialty mental health clinics and psychiatric diagnosis patterns among patients of 118 primary care facilities that offered integrated mental health care with 142 facilities without this service, with adjustment for other facility characteristics.

Results: Patients at both types of primary care facilities (those with integrated mental health care and those without) initiated specialty mental health treatment at similar rates (5.

Initiation of Primary Care-Mental Health Integration programs in the VA Health System: associations with psychiatric diagnoses in primary care.

Background: Providing collaborative mental health treatment within primary care settings improves depression outcomes and may improve detection of mental disorders. Few studies have assessed the effect of collaborative mental health treatment programs on diagnosis of mental disorders in primary care populations. In 2008, many Department of Veterans Affairs (VA) facilities implemented collaborative care programs, as part of the VA's Primary Care-Mental Health Integration (PC-MHI) program.