Luke Rozema, Sarah L Cornelius, Brian Shiner, Bradley Vince Watts, Matthew Vincenti
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引用次数: 0
Abstract
Objective: Mental health care is delivered by teams that include social workers, psychologists, nonphysician prescribing clinicians (NPPCs), and physicians. The objective of this study was to determine whether patient rurality has an effect on the types of U.S. Department of Veterans Affairs (VA) clinicians delivering psychotherapy and prescribing antidepressants to veterans.
Methods: Patients (N=3,537,595) receiving VA mental health services between 2013 and 2022 were stratified by rural, micropolitan, and metropolitan residence. A generalized estimating equation with a negative binomial distribution was used to estimate rates of psychotherapy delivered by social workers or psychologists and antidepressant prescribing rates by NPPCs or physicians. Rate ratios (RRs) comparing rural with metropolitan patients were calculated for each fiscal year.
Results: Total psychotherapy visit rates were similar for rural, micropolitan, and metropolitan veterans, but women received psychotherapy from psychologists at higher rates than men and combat veterans received psychotherapy from psychologists at higher rates than noncombat veterans. Rural patients received psychotherapy from social workers more often (RR=1.24-1.30) and from psychologists less often (RR=0.80-0.88) than metropolitan patients. Rural patients were given prescriptions for antidepressants by NPPCs more often (RR=1.28-1.36) and by physicians less often (RR=0.87-0.92) than metropolitan patients.
Conclusions: Rural veterans with mental health conditions receive more of their psychotherapy and antidepressant prescriptions from clinicians with master's- versus doctoral-level training. Future work should assess how rural-urban differences in mental health care delivery affect patient satisfaction, cost, and clinical outcomes.
期刊介绍：
Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Association. The peer-reviewed journal features research reports on issues related to the delivery of mental health services, especially for people with serious mental illness in community-based treatment programs. Long known as an interdisciplinary journal, Psychiatric Services recognizes that provision of high-quality care involves collaboration among a variety of professionals, frequently working as a team. Authors of research reports published in the journal include psychiatrists, psychologists, pharmacists, nurses, social workers, drug and alcohol treatment counselors, economists, policy analysts, and professionals in related systems such as criminal justice and welfare systems. In the mental health field, the current focus on patient-centered, recovery-oriented care and on dissemination of evidence-based practices is transforming service delivery systems at all levels. Research published in Psychiatric Services contributes to this transformation.
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