Johnson Christopher E, Bush Ruth L, Harman Jeffrey, Bolin Jane, Evans Hudnall Gina, Nguyen Ann M
Department of Health Services, School of Public Health, University of Washington, Seattle, Washington.
College of Medicine, Texas A&M Health Science Center, Round Rock, Texas.
J Rural Health. 2015 Summer;31(3):244-53. doi: 10.1111/jrh.12105. Epub 2015 Jan 19.
Rural-dwelling Department of Veterans Affairs (VA) enrollees are at high risk for a wide variety of mental health-related disorders. The objective of this study is to examine the variation in the types of mental and nonmental health services received by rural VA enrollees who have a mental health-related diagnosis.
The Andersen and Aday behavioral model of health services use and the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey (MEPS) data were used to examine how VA enrollees with mental health-related diagnoses accessed places of care from 1999 to 2009. Population survey weights were applied to the MEPS data, and logit regression was conducted to model how predisposing, enabling, and need factors influence rural veteran health services use (measured by visits to different places of care). Analyses were performed on the subpopulations: rural VA, rural non-VA, urban VA, and urban non-VA enrollees.
For all types of care, both rural and urban VA enrollees received care from inpatient, outpatient, office-based, and emergency room settings at higher odds than urban non-VA enrollees. Rural VA enrollees also received all types of care from inpatient, office-based, and emergency room settings at higher odds than urban VA enrollees. Rural VA enrollees had higher odds of a mental health visit of any kind compared to urban VA and non-VA enrollees.
Based on these variations, the VA may want to develop strategies to increase screening efforts in inpatient settings and emergency rooms to further capture rural VA enrollees who have undiagnosed mental health conditions.
美国退伍军人事务部（VA）农村登记在册人员患各种心理健康相关疾病的风险很高。本研究的目的是调查被诊断患有心理健康相关疾病的农村VA登记在册人员接受的心理健康和非心理健康服务类型的差异。
采用安德森和阿代的卫生服务利用行为模型以及医疗保健研究与质量局医疗支出小组调查（MEPS）数据，研究1999年至2009年期间被诊断患有心理健康相关疾病的VA登记在册人员如何获得医疗服务场所。将人口调查权重应用于MEPS数据，并进行逻辑回归，以模拟易患因素、促成因素和需求因素如何影响农村退伍军人的卫生服务利用情况（通过到不同医疗服务场所就诊来衡量）。对农村VA、农村非VA、城市VA和城市非VA登记在册人员亚群体进行了分析。
对于所有类型的护理，农村和城市VA登记在册人员从住院、门诊、门诊办公室和急诊室获得护理的几率均高于城市非VA登记在册人员。农村VA登记在册人员从住院、门诊办公室和急诊室获得所有类型护理的几率也高于城市VA登记在册人员。与城市VA和非VA登记在册人员相比，农村VA登记在册人员进行任何类型心理健康就诊的几率更高。
基于这些差异，VA可能需要制定策略，加强住院环境和急诊室的筛查工作，以进一步发现未被诊断出患有心理健康问题的农村VA登记在册人员。
