Almklov Erin, Lee Michael W, Gault John D, Blanco Brian H, Huynh Brian, Angkaw Abigail, Doran Neal, Afari Niloofar, Pittman James O E
VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA.
VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr., San Diego, CA, USA.
BMC Health Serv Res. 2025 Jan 3;25(1):10. doi: 10.1186/s12913-024-12029-1.
2022 survey data showed 29% of Veterans utilized Veterans Affairs (VA) paid health care at a non-VA facility, 6% higher than in 2021. Despite an increase in the number of Veterans accessing care in the community via the MISSION Act Community Care Program (CCP), there is limited information on the quality of mental health care delivered to Veterans in these settings. Further, Veterans report barriers to quality care, including poor communication between CCP and VA providers, which can result in negative patient outcomes. We aimed to evaluate the feasibility and acceptability of using electronic screening, eScreening, as part of a process involving remote symptom screening, symptom monitoring, and clinically driven communication from VA to CCP providers, for Veterans accessing mental health treatment in CCP settings.
Veterans (n = 150) diagnosed with major depressive disorder, an anxiety disorder, post-traumatic stress disorder, and/or an adjustment disorder referred to mental health care in CCP between August-November 2021 were eligible to participate. Veterans received an eScreening link to complete an initial web-based assessment and three follow-up assessments spaced 4-6 weeks apart over the course of their treatment. Quantitative assessment data was largely characterized using descriptive statistics and included patient-reported outcome (PRO) measures (PTSD and depression), health-related quality of life/functioning, community care information (e.g., number of sessions attended), and satisfaction with the eScreening technology. Qualitative interview data was also collected from participating Veterans and CCP providers to better understand experiences with eScreening.
Findings support the feasibility and acceptability of using eScreening to administer and monitor PROs for Veterans accessing mental health treatment in CCP. Of the Veterans who provided eScreening satisfaction ratings (Ns = 45-55), 89% had no technical difficulties; 78% felt comfortable entering personal information; and 83% were neutral or positive about ease of use. Focus group interviews revealed strong support from Veterans, who stated the software was easy to use; they felt comfortable completing PRO measures; and they appreciated having their symptoms monitored. Similarly, providers indicated eScreening had a positive impact on communication, collaboration of care, and transparency.
Technologies like eScreening represent a promising tool to support the mental health care Veterans receive when they access CCP.
2022年的调查数据显示，29%的退伍军人在非退伍军人事务部（VA）的医疗机构使用VA支付的医疗服务，这一比例比2021年高6%。尽管通过《使命法案》社区护理计划（CCP）在社区接受护理的退伍军人数量有所增加，但关于在这些环境中为退伍军人提供的心理健康护理质量的信息有限。此外，退伍军人报告了获得优质护理的障碍，包括CCP与VA提供者之间沟通不畅，这可能导致负面的患者结果。我们旨在评估使用电子筛查（eScreening）作为涉及远程症状筛查、症状监测以及从VA到CCP提供者的临床驱动沟通过程的一部分，对于在CCP环境中接受心理健康治疗的退伍军人的可行性和可接受性。
2021年8月至11月期间被转介至CCP接受心理健康护理、被诊断患有重度抑郁症、焦虑症、创伤后应激障碍和/或适应障碍的退伍军人（n = 150）有资格参与。退伍军人收到一个eScreening链接，以完成初始的基于网络的评估以及在其治疗过程中相隔4 - 6周的三次随访评估。定量评估数据主要使用描述性统计进行描述，包括患者报告结局（PRO）指标（创伤后应激障碍和抑郁症）、健康相关生活质量/功能、社区护理信息（例如就诊次数）以及对eScreening技术的满意度。还从参与的退伍军人和CCP提供者那里收集了定性访谈数据，以更好地了解eScreening的体验。
研究结果支持使用eScreening为在CCP接受心理健康治疗的退伍军人管理和监测PRO的可行性和可接受性。在提供eScreening满意度评分的退伍军人中（n = 45 - 55），89%没有技术困难；78%对输入个人信息感到放心；83%对易用性持中立或积极态度。焦点小组访谈显示退伍军人给予了大力支持，他们表示该软件易于使用；他们对完成PRO指标感到放心；并且他们对自己的症状受到监测表示感激。同样，提供者表示eScreening对沟通、护理协作和透明度有积极影响。
像eScreening这样的技术是一种很有前景的工具，可支持退伍军人在接受CCP服务时获得心理健康护理。
