Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Gen Intern Med. 2023 Nov;38(14):3144-3151. doi: 10.1007/s11606-023-08296-z. Epub 2023 Jul 13.
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.
To examine the relationship between veteran WH utilization and subsequent engagement in EBP.
Retrospective analysis of VHA administrative records from 18 facilities implementing WH.
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.
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.
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.
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.
在有行为健康问题的退伍军人中，参与基于证据的心理治疗（EBP）的情况往往很低。退伍军人事务部（VA）正在实施“整体健康（WH）”护理系统，以确定退伍军人的个人健康目标，使护理与这些目标保持一致，并提供旨在使退伍军人参与并赋予他们实现健康的服务。
研究退伍军人 WH 使用与随后参与 EBP 的关系。
对实施 WH 的 18 个设施的 VA 行政记录进行回顾性分析。
在 2018 财年有抑郁、创伤后应激障碍（PTSD）和/或焦虑症诊断但在该财年没有使用 EBP 的退伍军人（n=265364）。在这一队列中，有 33146 人（12.5%）在 2019 财年开始使用 WH。
我们比较了 WH 使用的退伍军人在索引日期后的 1 年内使用抑郁、焦虑和/或 PTSD 的 EBP 与在 WH 未被确定使用的退伍军人在 2019 财年期间使用 EBP 的任何时间，使用多元逻辑回归检查退伍军人 WH 使用与 EBP 参与之间的关联。
在我们的总体队列中，大约有 3.0%（n=7860）的退伍军人在索引日期后的一年中参与了 EBP。控制关键人口统计学、健康和利用变量后，与没有 WH 利用的退伍军人相比，WH 用户在次年接受 EBP 的可能性高 2.4 倍（95%CI：2.2-2.5）。在随后的一年里，使用特定 WH 服务（与未使用该服务相比）与接受 EBP 之间的关联，在不同类型的 WH 服务中，从 1.6（95%CI：1.0-2.6）到 3.5（95%CI：3.2-3.9）不等。
WH 的使用与退伍军人抑郁、焦虑和/或 PTSD 中 EBP 的参与增加有关。未来旨在促进退伍军人参与 EBP 的干预措施可能受益于利用 WH 服务和治疗。
