1. Who is Using Behavioral Health Services in Integrated Primary Care? Mary Schohn, PhD Dawn Edwards, PhD VHA Center for Integrated Healthcare

2. Background Since 1998, VISN 2 has been offering Behavioral health services in primary care using a model of integrated care. Behavioral health services offered include:  Early identification and treatment of behavioral health issues within primary care  Behavioral interventions that address needed lifestyle changes to improve physical health  Assistance with referral to specialty mental health services

3. Current Study Sample: All Patients who had a Primary Care Encounter between January 1st and March 31st of 2005. N = 86,326  BH sample = Patients who had at least one encounter with the behavioral health provider in primary care between 1/1/05 and 3/31/05 N= 7,192 (9%)  PH sample = Patients without a behavioral health encounter within primary care between 1/105 and 3/31/05 N= 79,134 (91%)

4. Results BH Non-BH Demographics  Age57.4 (13.8) 66.2(14.0)**  %Male 92% 96%**  % White90% 91%*  Means Test Screening  Elevated Audit C36% (x=3.5) 32% (x=2.9 )**  Elevated GHQ 40% (x=4.1) 9% (x=2.4)**

5. Clinical Characteristics BHNon-BH MH Diagnosis  Depression 48% 7.0%**  Anxiety (non PTSD) 32% 5.6%**  PTSD 34% 5.4%**  Alcohol 21% 6.0%** Psychotropic Medication Usage  Antidepressant 69%18.0%**  Benzodiazepine 19% 5.9%**

6. Utilization BH Non-BH Where seen?  Albany10.0%8.7%  Batavia 3.9%3.6%  Bath 5.2%6.3%  Binghamton.1%4.1%  Buffalo15.0% 14.4%  Canandaigua 7.3% 5.1%  Rochester 4.9% 8.4%  Rome 0.5% 5.6%  Syracuse 5.0% 10.0%  All other CBOCs49.0%34.0%

7. Additional Information BHNon-BH Other services used  Emergency room care 31.0% 19.0%**  Geriatric care 1.9% 0.8%* Other illness  % Cholesterol >200 27.0%20.0%**  % HbA1c >7 2.0% 3.0%  %HTN53.0% 62.0%**  Backache NOS 7.6% 3.7%**

8. Conclusions Primary Care Behavioral Health Providers are being utilized by veterans with traditional mental health concerns Limited use by veterans with behavioral medicine or lifestyle concerns (e.g. elevated HbA1c, hypertension) Variable service use across sites

9. Additional Opportunities Opportunity exists for much greater utilization of services by veterans with behavioral medicine concerns Lifestyle Modification Support (e.g. for elevated HbA1c, elevated cholesterol, hypertension, obesity, smoking) Stress/Anxiety Management (e.g. pulmonary, cardiac, headache patients) Coping Skills (e.g. managing arthritis, chronic pain, other disabilities) Veterans with alcohol disorders BH involvement with all veterans newly prescribed psychotropics