Content area
Abstract
Background
Engagement in evidence-based psychotherapy (EBP) among veterans with behavioral health conditions is often low. The Veterans Health Administration (VHA) is implementing a “Whole Health (WH)” system of care, to identify veteran personal health goals, align care with those goals, and offer services designed to engage and empower veterans to achieve well-being.
Objective
To examine the relationship between veteran WH utilization and subsequent engagement in EBP.
Design
Retrospective analysis of VHA administrative records from 18 facilities implementing WH.
Subjects
Veterans (n = 265,364) with a diagnosis of depression, post-traumatic stress disorder (PTSD), and/or anxiety who had a mental healthcare encounter but no EBP use in fiscal year (FY) 2018. Among this cohort, 33,146 (12.5%) began using WH in FY2019.
Main Measures
We examined use of an EBP for depression, anxiety, and/or PTSD within 1 year of the index date of WH use compared to use of an EBP anytime during FY2019 for veterans not identified as using WH. We used multiple logistic regression to examine the association between veteran WH use and EBP engagement.
Key Results
Approximately 3.0% (n = 7,860) of the veterans in our overall cohort engaged in an EBP in the year following their index date. Controlling for key demographic, health, and utilization variables, WH users had 2.4 (95% CI: 2.2–2.5) times higher odds of engaging in an EBP the following year than those with no WH utilization. Associations between utilization of specific WH services (vs. no utilization of that service) and engagement in an EBP in the subsequent year ranged from 1.6 (95% CI: 1.0–2.6) to 3.5 (95% CI: 3.2–3.9) across the different types of WH services used.
Conclusions
WH use was associated with increased engagement in EBPs among veterans with depression, anxiety, and/or PTSD. Future interventions intended to promote veteran engagement in EBPs may benefit from leveraging WH services and therapies.
Details
1 Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, USA (GRID:grid.280893.8) (ISNI:0000 0004 0419 5175)
2 Edward Hines Jr. VA Hospital, Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, USA (GRID:grid.280893.8) (ISNI:0000 0004 0419 5175); Northwestern University Feinberg School of Medicine, Chicago, USA (GRID:grid.16753.36) (ISNI:0000 0001 2299 3507)
3 VA Puget Sound Healthcare System, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, USA (GRID:grid.413919.7) (ISNI:0000 0004 0420 6540); University of Washington School of Public Health, Seattle, USA (GRID:grid.34477.33) (ISNI:0000000122986657)
4 VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA (GRID:grid.34477.33)
5 VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA (GRID:grid.34477.33); Boston University School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
6 VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA (GRID:grid.189504.1); Boston University School of Medicine, Boston, USA (GRID:grid.189504.1) (ISNI:0000 0004 1936 7558)
7 VA Puget Sound Healthcare System, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, USA (GRID:grid.413919.7) (ISNI:0000 0004 0420 6540)
8 VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA (GRID:grid.413919.7); University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, Worcester, USA (GRID:grid.168645.8) (ISNI:0000 0001 0742 0364)
9 VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA (GRID:grid.168645.8); UT Southwestern Medical Center, Peter O’Donnell Jr. School of Public Health, Dallas, USA (GRID:grid.267313.2) (ISNI:0000 0000 9482 7121)
10 VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA (GRID:grid.267313.2); University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, Worcester, USA (GRID:grid.168645.8) (ISNI:0000 0001 0742 0364)