TY - JOUR
AU - J. Resnik
AU - C. J. Miller
AU - C. E. Roth
AU - K. Burns
AU - M. J. Bovin
A1 - 
AB - INTRODUCTION: Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation. MATERIALS AND METHODS: We conducted a systematic review of PubMed and PTSDpubs between May 2019 and January 2022 to identify DVA access interventions for veterans with PTSD not engaged in DVA mental health care. We identified 17 interventions and 29 manuscripts reporting quantitative access outcomes. We categorized interventions into four major categories: Primary care mental health integration, other national initiatives, telemental health, and direct outreach. We evaluated five outcome domains: Binary attendance, number of sessions attended, wait time, number of patients seen, and care initiation. We assessed the risk of bias using the Cochrane Collaboration criteria. RESULTS: Across articles, binary attendance generally improved, whereas the impact on the number of sessions attended was equivocal. Overall, the number of patients seen increased compared to control participants and retrospective data. The few articles that examined care initiation had mixed results. Only one article examined the impact on wait time. CONCLUSIONS: Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
AD - VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA.; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.; VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA.; Boston VA Research Institute (BVARI), Boston, MA 02130, USA.; Emmanuel College, Boston, MA 02115, USA.; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA.
AN - 37837200
BT - Mil Med
C5 - Healthcare Disparities; HIT & Telehealth
DA - Oct 13
DO - 10.1093/milmed/usad376
DP - NLM
ET - 20231013
JF - Mil Med
LA - eng
N2 - INTRODUCTION: Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation. MATERIALS AND METHODS: We conducted a systematic review of PubMed and PTSDpubs between May 2019 and January 2022 to identify DVA access interventions for veterans with PTSD not engaged in DVA mental health care. We identified 17 interventions and 29 manuscripts reporting quantitative access outcomes. We categorized interventions into four major categories: Primary care mental health integration, other national initiatives, telemental health, and direct outreach. We evaluated five outcome domains: Binary attendance, number of sessions attended, wait time, number of patients seen, and care initiation. We assessed the risk of bias using the Cochrane Collaboration criteria. RESULTS: Across articles, binary attendance generally improved, whereas the impact on the number of sessions attended was equivocal. Overall, the number of patients seen increased compared to control participants and retrospective data. The few articles that examined care initiation had mixed results. Only one article examined the impact on wait time. CONCLUSIONS: Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
PY - 2023
SN - 0026-4075
ST - A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD
T1 - A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD
T2 - Mil Med
TI - A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD
U1 - Healthcare Disparities; HIT & Telehealth
U3 - 10.1093/milmed/usad376
VO - 0026-4075
Y1 - 2023
ER -