Post-traumatic stress disorder (PTSD) is thought to affect nearly one-fifth of Veterans of Operations Enduring Freedom (OEF;Afghanistan), Iraqi Freedom (OIF;Iraq), and New Dawn (OND;Iraq). Recognizing that evidence-based practices (EBPs) for PTSD can result in significant symptom reduction and improved quality of life for Veterans with the disorder, the Department of Veterans Affairs (VA) has invested in making EBPs for PTSD available at every VA facility nationwide. Such efforts to improve access to EBPs for PTSD have been stymied, however, by the fact that many recent Veterans elect to seek care in community settings rather than with VA. The proposed pilot research will inform VA efforts to improve access to high- quality, patient-centered care by comparing PTSD care utilization patterns among OEF/OIF/OND Veterans with PTSD living in Texas and identifying individual- and community-level factors associated with choice of VA or non-VA care setting. As Texas has the nation's second largest population of Veterans, with widely varying demographics and access to VA and other services, it provides an excellent case study for examining care- seeking, access to care, and care preferences among recent Veterans. METHODS: Our multi-disciplinary team will utilize a crosswalk of administrative data from the OEF/OIF/OND Roster and VETSNET to identify OEF/OIF/OND Veterans living in Texas who are service-connected for PTSD. We will then survey a stratified random sample of 1200 Veterans (estimated total n=400) to compare self-reported utilization of VA, military, and community-based care services, related patient-level factors as described in the model of Veterans'healthcare access developed at the most recent State of the Art (SOTA) Conference on Improving Access to VA Care (Fortney et al. 2011), and care preferences. We will also integrate patient-level information with Geographic Information Systems (GIS) data to examine whether geographic and community factors impact Veterans'PTSD care-seeking. With these methods, we will achieve the following aims: Objective 1. Compare demographic characteristics of OEF/OIF/OND Veterans with PTSD in Texas who report different patterns of PTSD care utilization: a) VA USERS who have only sought care for PTSD in VA settings since receiving their diagnosis;b) NON-VA USERS who have only sought PTSD care in non-VA settings, including military and/or community-based facilities, since diagnosis;c) DUAL USERS who have used both VA and non-VA PTSD care services since diagnosis;and d) NON-USERS who report no use of PTSD care services since diagnosis. Objective 2. Compare PTSD care preferences, perceived access and perceived need for care among individuals with different patterns of PTSD care utilization. Objective 3. Identify geographic factors such as proximity and density of PTSD care services associated with different patterns of PTSD care utilization. Dissemination and Next Steps: Pilot study findings will be used to inform an Investigator Initiated Research (IIR) proposal to develop and validate in a national sample a predictive model for understanding Veterans'PTSD care utilization in both VA and non-VA settings. This predictive model will support improved access to evidence-based PTSD care for Veterans by providing information to aid state and local and national VA mental health leadership in identifying targeted multi-level strategies for increasing Veterans'PTSD care access and engagement. Pilot study findings will have immediate operational relevance and will be disseminated to VA, state, and national partners.
This HSR&D Pilot proposal will inform VA efforts to improve access to high-quality care for post-traumatic stress disorder (PTSD) by describing care utilization patterns among OEF/OIF/OND Veterans with PTSD living in Texas and identifying individual- and community-level factors associated with choice of VA or non-VA care setting. Our multi-disciplinary team will utilize a crosswalk of administrative data from the OEF/OIF/OND Roster and VETSNET to identify Veterans who are service-connected for PTSD, then survey a stratified random sample (n=1200) to assess self-reported utilization of VA, military and/or community-based PTSD care services, related patient-level factors, and care preferences. Survey results will be integrated with Geographic Information Systems (GIS) data to identify individual and geospatial factors associated with Veterans'PTSD care-seeking. Pilot study findings will be used to inform an Investigator Initiated Research (IIR) proposal to develop a predictive model for understanding Veterans'PTSD care utilization in both VA and non-VA settings.
