Reducing barriers to mental health and social services for Iraq and Afghanistan veterans: outcomes of an integrated primary care clinic.

Abstract:

BACKGROUND:Despite high rates of post-deployment psychosocial problems in Iraq and Afghanistan veterans, mental health and social services are under-utilized. OBJECTIVE:To evaluate whether a Department of Veterans Affairs (VA) integrated care (IC) clinic (established in April 2007), offering an initial three-part primary care, mental health and social services visit, improved psychosocial services utilization in Iraq and Afghanistan veterans compared to usual care (UC), a standard primary care visit with referral for psychosocial services as needed. DESIGN:Retrospective cohort study using VA administrative data. POPULATION:Five hundred and twenty-six Iraq and Afghanistan veterans initiating primary care at a VA medical center between April 1, 2005 and April 31, 2009. MAIN MEASURES:Multivariable models compared the independent effects of primary care clinic type (IC versus UC) on mental health and social services utilization outcomes. KEY RESULTS:After 2007, compared to UC, veterans presenting to the IC primary care clinic were significantly more likely to have had a within-30-day mental health evaluation (92% versus 59%, p < 0.001) and social services evaluation [77% (IC) versus 56% (UC), p < 0.001]. This exceeded background system-wide increases in mental health services utilization that occurred in the UC Clinic after 2007 compared to before 2007. In particular, female veterans, younger veterans, and those with positive mental health screens were independently more likely to have had mental health and social service evaluations if seen in the IC versus UC clinic. Among veterans who screened positive for  ≥ 1 mental health disorder(s), there was a median of 1 follow-up specialty mental health visit within the first year in both clinics. CONCLUSIONS:Among Iraq and Afghanistan veterans new to primary care, an integrated primary care visit further improved the likelihood of an initial mental health and social services evaluation over background increases, but did not improve retention in specialty mental health services.

journal_name

J Gen Intern Med

authors

Seal KH,Cohen G,Bertenthal D,Cohen BE,Maguen S,Daley A

doi

10.1007/s11606-011-1746-1

subject

Has Abstract

pub_date

2011-10-01 00:00:00

pages

1160-7

issue

10

eissn

0884-8734

issn

1525-1497

journal_volume

26

pub_type

杂志文章
  • Factors influencing disease self-management among veterans with diabetes and poor glycemic control.

    abstract:SPECIFIC AIM:Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes....

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-006-0053-8

    authors: Nelson KM,McFarland L,Reiber G

    更新日期:2007-04-01 00:00:00

  • The disavowed curriculum: understanding student's reasoning in professionally challenging situations.

    abstract:CONTEXT:Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE:Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN:Qualitative study usin...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2003.21247.x

    authors: Ginsburg S,Regehr G,Lingard L

    更新日期:2003-12-01 00:00:00

  • Confined to ignorance: the absence of prisoner information from nationally representative health data sets.

    abstract:BACKGROUND:Incarceration is associated with poor health and high costs. Given the dramatic growth in the criminal justice system's population and associated expenses, inclusion of questions related to incarceration in national health data sets could provide essential data to researchers, clinicians and policy-makers. ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-011-1858-7

    authors: Ahalt C,Binswanger IA,Steinman M,Tulsky J,Williams BA

    更新日期:2012-02-01 00:00:00

  • Utilization and dosing of angiotensin-converting enzyme inhibitors for heart failure. Effect of physician specialty and patient characteristics.

    abstract::To determine if physician specialty is associated with underutilization and underdosing of angiotensin-converting enzyme inhibitors among patients with heart failure, we reviewed the charts of 214 outpatients with decreased systolic function at an urban academic medical center. Regardless of whether patients were care...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1997.07110.x

    authors: Chin MH,Wang JC,Zhang JX,Lang RM

    更新日期:1997-09-01 00:00:00

  • The long-term health outcomes of childhood abuse. An overview and a call to action.

    abstract::While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical hea...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1046/j.1525-1497.2003.20918.x

    authors: Springer KW,Sheridan J,Kuo D,Carnes M

    更新日期:2003-10-01 00:00:00

  • A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients.

    abstract::Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3608-3

    authors: DeMeester RH,Lopez FY,Moore JE,Cook SC,Chin MH

    更新日期:2016-06-01 00:00:00

  • Knowledge and perceptions of colorectal cancer screening among urban African Americans.

    abstract:OBJECTIVE:To explore colorectal cancer (CRC) screening knowledge, attitudes, barriers, and preferences among urban African Americans as a prelude to the development of culturally appropriate interventions to improve screening for this group. DESIGN:Qualitative focus group study with assessment of CRC screening prefere...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2005.00165.x

    authors: Greiner KA,Born W,Nollen N,Ahluwalia JS

    更新日期:2005-11-01 00:00:00

  • The effect of resident involvement on community hospital charges.

    abstract::Attempts to explain the high cost of care in teaching hospitals have yielded conflicting results. This study was conducted to compare hospital charges and lengths of stay for two groups of patients: one cared for by a resident team and the other cared for by attending physicians. The study was conducted at a universit...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02602350

    authors: Dunn PM,Parker DF,Levinson W,Mullooly JP

    更新日期:1989-03-01 00:00:00

  • Tips for teachers of evidence-based medicine: making sense of decision analysis using a decision tree.

    abstract::Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners unde...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-009-0918-8

    authors: Lee A,Joynt GM,Ho AM,Keitz S,McGinn T,Wyer PC,EBM Teaching Scripts Working Group.

    更新日期:2009-05-01 00:00:00

  • Ethical Implications of the Electronic Health Record: In the Service of the Patient.

    abstract::Electronic health records (EHRs) provide benefits for patients, physicians, and clinical teams, but also raise ethical questions. Navigating how to provide care in the digital age requires an assessment of the impact of the EHR on patient care and the patient-physician relationship. EHRs should facilitate patient care...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-017-4030-1

    authors: Sulmasy LS,López AM,Horwitch CA,, American College of Physicians Ethics, Professionalism and Human Rights Committee.

    更新日期:2017-08-01 00:00:00

  • The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study.

    abstract:BACKGROUND:Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes. OBJECTIVE:To examine the effect of isolation precautions on hospital-related outcomes and c...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-016-3862-4

    authors: Tran K,Bell C,Stall N,Tomlinson G,McGeer A,Morris A,Gardam M,Abrams HB

    更新日期:2017-03-01 00:00:00

  • Medical risks for women who drink alcohol.

    abstract:OBJECTIVE:To summarize for clinicians recent epidemiologic evidence regarding medical risks of alcohol use for women. METHODS:MEDLINE and PsychINFO, 1990 through 1996, were searched using key words "women" or "woman," and "alcohol." MEDLINE was also searched for other specific topics and authors from 1980 through 1996...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1046/j.1525-1497.1998.cr187.x

    authors: Bradley KA,Badrinath S,Bush K,Boyd-Wickizer J,Anawalt B

    更新日期:1998-09-01 00:00:00

  • Extent and determinants of discrepancy between self-evaluations of weight status and clinical standards.

    abstract:OBJECTIVES:To examine the extent and type of discordance between personal and medical classifications of weight status, and to examine the influence of sociodemographic factors on the misclassification of weight status. DESIGN/SETTING:The 1991 Health Promotion and Disease Prevention Supplement of the National Health I...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.2001.016008538.x

    authors: Chang VW,Christakis NA

    更新日期:2001-08-01 00:00:00

  • Patient perspectives of medical confidentiality: a review of the literature.

    abstract:OBJECTIVE:To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN:Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1046/j.1525-1497.2003.20823.x

    authors: Sankar P,Mora S,Merz JF,Jones NL

    更新日期:2003-08-01 00:00:00

  • Continuity of care and patient outcomes after hospital discharge.

    abstract:BACKGROUND:Patients are often treated in hospital by physicians other than their regular community doctor. After they are discharged, their care is often returned to their regular community doctor and patients may not see the hospital physician. Transfer of information between physicians can be poor. We determined whet...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2004.30082.x

    authors: van Walraven C,Mamdani M,Fang J,Austin PC

    更新日期:2004-06-01 00:00:00

  • The effect of charge display on cost of care and physician practice behaviors: a systematic review.

    abstract:BACKGROUND:While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted. OBJECTIVE:We aimed to determine the type and quality of charge display studies that have been published; to synthes...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-015-3226-5

    authors: Goetz C,Rotman SR,Hartoularos G,Bishop TF

    更新日期:2015-06-01 00:00:00

  • A transitional opioid program to engage hospitalized drug users.

    abstract:BACKGROUND:Many opioid-dependent patients do not receive care for addiction issues when hospitalized for other medical problems. Based on 3 years of clinical practice, we report the Transitional Opioid Program (TOP) experience using hospitalization as a "reachable moment" to identify and link opioid-dependent persons t...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-010-1311-3

    authors: Shanahan CW,Beers D,Alford DP,Brigandi E,Samet JH

    更新日期:2010-08-01 00:00:00

  • Measuring compliance with preventive care guidelines: standardized patients, clinical vignettes, and the medical record.

    abstract:OBJECTIVE:To determine how accurately preventive care reported in the medical record reflects actual physician practice or competence. DESIGN:Scoring criteria based on national guidelines were developed for 7 separate items of preventive care. The preventive care provided by randomly selected physicians was measured p...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1046/j.1525-1497.2000.91007.x

    authors: Dresselhaus TR,Peabody JW,Lee M,Wang MM,Luck J

    更新日期:2000-11-01 00:00:00

  • Potentially Preventable Spending Among High-Cost Medicare Patients: Implications for Healthcare Delivery.

    abstract:BACKGROUND:High-cost patients account for a disproportionate share of healthcare spending. The proportion and distribution of potentially preventable spending among subgroups of high-cost patients are largely unknown. OBJECTIVE:To examine the distribution of potentially preventable spending among high-cost Medicare pa...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-05691-8

    authors: Khullar D,Zhang Y,Kaushal R

    更新日期:2020-10-01 00:00:00

  • Health Literacy and Shared Decision-making: Exploring the Relationship to Enable Meaningful Patient Engagement in Healthcare.

    abstract::Research into health literacy and shared decision-making has largely developed along parallel, but distinct lines over the past two decades. There is little evidence that the concepts and related practice have intersected except in the most functional way, for example, to simplify shared decision-making tools by impro...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-05912-0

    authors: Muscat DM,Shepherd HL,Nutbeam D,Trevena L,McCaffery KJ

    更新日期:2020-05-29 00:00:00

  • Quality of care and racial disparities in medicare among potential ACOs.

    abstract:BACKGROUND:The Medicare Accountable Care Organization (ACO) programs encourage integration of providers into large groups and reward provider groups for improving quality, but not explicitly for reducing health care disparities. Larger group size and better overall quality may or may not be associated with smaller disp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-014-2900-3

    authors: Anderson RE,Ayanian JZ,Zaslavsky AM,McWilliams JM

    更新日期:2014-09-01 00:00:00

  • The impact of the internal medicine sub-internship on medical student career choice.

    abstract:BACKGROUND:Medical student interest in internal medicine is decreasing. Whether the internal medicine sub-internship affects intent to pursue internal medicine is unknown. OBJECTIVE:Determine the immediate and longer-term effect of the medicine sub-internship on students' decision to pursue internal medicine residency...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-010-1263-7

    authors: Kogan JR,Shea JA,O'Grady E,Bellini LM,Ciminiello F

    更新日期:2010-05-01 00:00:00

  • Motivation for hepatitis B vaccine acceptance among medical and physician assistant students.

    abstract:PURPOSE:To evaluate the acceptance rate and motivation for acceptance of hepatitis B virus (HBV) vaccine among preclinical medical and physician assistant (PA) students in comparison with similar data obtained from resident and staff physicians. METHODS:A cross-sectional survey of all second-year medical and PA studen...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02599567

    authors: Diekema DJ,Ferguson KJ,Doebbeling BN

    更新日期:1995-01-01 00:00:00

  • Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial.

    abstract:PURPOSE:Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controll...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-05769-3

    authors: Jerant A,Duberstein P,Kravitz RL,Stone DM,Cipri C,Franks P

    更新日期:2020-07-01 00:00:00

  • Effectiveness and Reach of the Primary Palliative Care for Emergency Medicine (PRIM-ER) Pilot Study: a Qualitative Analysis.

    abstract:BACKGROUND:Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centered outcomes. OBJECTIVE:To understand the facilitators that contributed to the success of the Primary Palliative Care for Emergency Medicine (PRIM-ER) quality improvement pilot in...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06302-2

    authors: Chung FR,Turecamo S,Cuthel AM,Grudzen CR,PRIM-ER Investigators.

    更新日期:2020-10-27 00:00:00

  • Efficacy of a one-month training block in psychosocial medicine for residents: a controlled study.

    abstract:STUDY OBJECTIVE:To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents. DESIGN:Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching. SETTING:Com...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02598223

    authors: Smith RC,Osborn G,Hoppe RB,Lyles JS,Van Egeren L,Henry R,Sego D,Alguire P,Stoffelmayr B

    更新日期:1991-11-01 00:00:00

  • A traditionally administered short course failed to improve medical students' diagnostic performance. A quantitative evaluation of diagnostic thinking.

    abstract:BACKGROUND:Quite often medical students or novice residents have difficulty in ruling out diseases even though they are quite unlikely and, due to this difficulty, such students and novice residents unnecessarily repeat laboratory or imaging tests. OBJECTIVE:To explore whether or not a carefully designed short trainin...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2004.30257.x

    authors: Noguchi Y,Matsui K,Imura H,Kiyota M,Fukui T

    更新日期:2004-05-01 00:00:00

  • Patient Satisfaction with Clinicians and Short-Term Mortality in a US National Sample: the Roles of Morbidity and Gender.

    abstract:BACKGROUND:In a prior study, we found patient satisfaction was associated with mortality. However, that study included few deaths, yielding wide confidence intervals, was criticized for possible morbidity under-adjustment, and lacked power to explore sociodemographic moderation. OBJECTIVE:To revisit the satisfaction-m...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05058-8

    authors: Jerant A,Fiscella K,Fenton JJ,Magnan EM,Agnoli A,Franks P

    更新日期:2019-08-01 00:00:00

  • Asian Americans' reports of their health care experiences. Results of a national survey.

    abstract:OBJECTIVE:To examine how Asian race/ethnicity affects patients' health care experiences and satisfaction with care. DESIGN:Telephone interview using random-digit dialing, stratified to over-sample adults living in areas with disproportionately large numbers of minorities. PARTICIPANTS AND SETTING:White (N = 3,205) an...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2004.30143.x

    authors: Ngo-Metzger Q,Legedza AT,Phillips RS

    更新日期:2004-02-01 00:00:00

  • Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care.

    abstract:BACKGROUND:A significant barrier to communication among patient care providers in hospitals is the geographic dispersion of team members. OBJECTIVE:To determine whether localizing physicians to specific patient care units improves nurse-physician communication and agreement on patients' plans of care. METHODS:We cond...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-009-1113-7

    authors: O'Leary KJ,Wayne DB,Landler MP,Kulkarni N,Haviley C,Hahn KJ,Jeon J,Englert KM,Williams MV

    更新日期:2009-11-01 00:00:00