Quality of Care for PTSD and Depression in the Military Health System: Phase I Report

Abstract

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Delivering Clinical Practice Guideline–Concordant Care for PTSD and Major Depression in Military Treatment Facilities

“…These findings are somewhat inconsistent with the findings of other recent work. For example, a recent review of pharmacy data found that 31.5 percent of patients with depression received at least four medications over one observation year (Hepner et al, 2017), whereas our provider-reported data showed that 11.6 percent were currently prescribed four or more medications. This discrepancy may be due to a difference in measurement.…”

“…This is consistent with the findings and recommendations of other recent work. For example, a recent review of pharmacy data found that 44.9 percent of service members diagnosed with PTSD received at least four medications over one observation year (Hepner et al, 2017). Differences by service were not significant (p = 0.55).…”

“…Similarly, fewer than half of service members received a follow-up visit within 30 days of starting new medication treatment for PTSD or depression . Recent analyses have also suggested that fewer than half of service members who received psychotherapy had documentation in their medical record indicating that these were guideline-concordant, evidence-based treatments (45 percent for PTSD; 30 percent for depression; Hepner et al, 2017).…”

“…The relative size of the Army PH workforce appears to reflect the higher proportions of soldiers receiving PH treatment compared with airmen, Marines, and sailors. In a recent study on the quality of PH care in the MHS (Hepner et al, 2017), Army personnel represented nearly 70 percent of an identified cohort of service members who received a diagnosis of PTSD in 2013, while Navy, Marine Corps, and Air Force personnel each accounted for approximately 10 percent.…”

Bridging Gaps in Mental Health Care: Lessons Learned from the Welcome Back Veterans Initiative

“…EBTs for mental health needs are not available in all health care settings (Tanielian and Jaycox, 2008). Although VHA has a number of quality measures and monitoring systems in place, DoD and civilian systems of care do not have robust performance-monitoring tools for quality improvement of mental health care (Burnam, Meredith, Tanielian, & Jaycox, 2009;Hepner et al, 2016;Hepner, Ferris, et al, 2017;Hepner, Sloss, et al, 2017). In addition, a recent RAND study on VA capacity found that, although VA health care quality fared well on many measures and domains compared with non-VA providers, quality performance was inconsistent across VA facilities, and quality improvement is needed in many areas (Hussey et al, 2015).…”