Perceptions of behavioral health care among veterans with substance use disorders: results from a national evaluation of mental health services in the Veterans Health Administration

Perceived helpfulness of treatment for alcohol use disorders: Findings from the World Mental Health Surveys

AIM

We examined prevalence and factors associated with receiving perceived helpful alcohol use disorder (AUD) treatment, and persistence in help-seeking after earlier unhelpful treatment.

METHODS

Data came from 27 community epidemiologic surveys of adults in 24 countries using the World Health Organization World Mental Health surveys (n = 93,843). Participants with a lifetime history of treated AUD were asked if they ever received helpful AUD treatment, and how many professionals they had talked to up to and including the first time they received helpful treatment (or how many ever, if they had not received helpful treatment).

RESULTS

11.8% of respondents with lifetime AUD reported ever obtaining treatment (n = 9378); of these, 44% reported that treatment was helpful. The probability of obtaining helpful treatment from the first professional seen was 21.8%; the conditional probability of subsequent professionals being helpful after earlier unhelpful treatment tended to decrease as more professionals were seen. The cumulative probability of receiving helpful treatment at least once increased from 21.8% after the first professional to 79.7% after the seventh professional seen, following earlier unhelpful treatment. However, the cumulative probability of persisting with up to seven professionals in the face of prior treatments being unhelpful was only 13.2%.

CONCLUSION

Fewer than half of people with AUDs who sought treatment found treatment helpful; the most important factor was persistence in seeking further treatment if a previous professional had not helped. Future research should examine how to increase the likelihood that AUD treatment is found to be helpful on any given contact.

Inpatients' assessment of outcome at psychiatric institutions: an analysis of predictors following a national cross-sectional survey in Norway

OBJECTIVES

The objective was to assess the importance of different types of predictors for patient-reported outcome, both background factors at the patient level and healthcare predictors related to structure and processes of healthcare.

DESIGN

Cross-sectional patient experience survey.

SETTING

All 280 secondary care institutions in Norway providing inpatient care for adult psychiatric patients.

PARTICIPANTS

1683 inpatients responded to the questionnaire on-site (73.4%).

PRIMARY OUTCOME MEASURES

The outcome scale of the Psychiatric Inpatient Patient Experience Questionnaire-On-Site was the primary dependent variable. The scale consists of five items relating to overall patient satisfaction, benefit of treatment and patient enablement. Regressions were used to assess predictors, for all patients and for five different patient groups reported by the patients including anxiety/depression, drug-related problems and eating disorders.

RESULTS

Multilevel linear regression for all patients showed that background factors related to overall current state, self-perceived mental health before admission and admission type were the most important predictors for patient-assessed outcome. Poor current state was associated with poor assessment of outcome (estimate: 8.64, p<0.001), poor health before admission was associated with better outcome (estimate: -6.89, p<0.001) and patients with urgent admission had poorer scores on the outcome scale (estimate: 4.40, p<0.001). A range of structure and healthcare variables were related to patient-assessed outcome, the most important being clinicians/personnel understanding your situation, treatment adjusted to your situation and adequate information about mental health condition.

CONCLUSIONS

Self-perceived mental health before admission, current overall state and type of admission were the most important background factors for patient-assessed outcome. The most important structure and process variables were related to patient-centred interaction. The background factors should be considered in case-mix adjustments of quality indicators, while the process variables could be used as focus areas in work aiming to improve patients' assessment of outcome.

The association of mental health program characteristics and patient satisfaction

OBJECTIVES

Satisfaction with care is an important patient-centered domain of health system quality. However, satisfaction measures are costly to collect and not directly modifiable. Therefore, we assessed the relationships between veterans' satisfaction and measures of modifiable aspects of Veterans Health Administration (VHA) mental health care programs.

STUDY DESIGN

For a sample of 6990 patients who received mental health care from the VHA in 2013, we used survey and administrative data to investigate the association of a suite of access and encounter satisfaction measures with a large collection of measures of program characteristics.

METHODS

We estimated risk-adjusted correlations between 6 satisfaction measures (across 2 domains: access and encounter satisfaction) and 28 mental health care program characteristics (across 4 domains: program reach, psychosocial service access, program intensity, and treatment continuity).

RESULTS

We found that satisfaction with access to care was higher than experiences with care encounters, but that broad measures of mental health care program reach and intensity were positively associated with both kinds of satisfaction. No measures of psychosocial service access were positively associated with access and encounter satisfaction. Most measures of treatment continuity were consistently and positively associated with both kinds of satisfaction.

CONCLUSIONS

As the VHA strives to increase access to, and provision of, mental health care, policy makers and program managers should be aware that satisfaction with care, as it is currently measured, may not rise as more patients initiate treatment, unless continuity of care is maintained or enhanced.