Primary care–non-profit partnerships: Improving PTSD screening and treatment access for veteran patients

Abstract

Introduction: Approximately 50% of 22 million American military veterans use civilian healthcare in addition to, or in lieu of, the Department of Veteran’s Affairs health facilities. Studies find that theses veterans may have unidentified mental health needs and lack access to appropriate mental health services. Barriers to adequate mental health care include: (a) undisclosed veteran status; (b) stigma; (c) lack of cultural competency in civilian healthcare; and (d) an overall shortage of mental health services. With veteran post-traumatic stress disorder rates as high as 23%, we conducted a quality improvement project to improve veteran identification, mental health needs assessment, and access to appropriate services for this underserved population.

Method: Over the course of three months, one multi-provider suburban and one two-provider rural primary care clinic (PCC) asked adult patients about veteran status; screened for PTSD risk using the Abbreviated PTSD Check List (aPCL); and referred patients to a veteran-centric case management not-for-profit organization (NFPO). We calculated veteran patient populations among the PCCs, PTSD risk rates, and referred patient utilization of NFPO services. Finally, a post-project focus group with PCC staff and providers captured perceptions about project implementation processes.

Results: 100 (11.7%) of nearly 850 screened patients identified as veterans. Of these, 95 completed the aPCL, 15 were referred, and 13 utilized NFPO services. Services included psychological and addiction counseling, financial and debt aid, and access to local VA information and services. Monthly screening rates declined from 60% to 17% by the third month, a decline attributed to (1) not screening previously screened patients and (2) non-adherence to project protocol. Clinic participants expressed enthusiasm for the project and reported that screening and assessment processes were simple.

Discussion: PCCs identified approximately one at-risk patient per week. Although PTSD screening was feasible and effective using minimal resources, clinic staff may need continued support to maintain consistency. The NFPO provided access to needed non-healthcare and veteran centric services. Successful implementation of future project iterations requires significant commitment across members of the partnership in order to effectively identify at-risk veterans and meet their ongoing health and social needs.