Veterans With Mental Health Diagnoses, Especially PTSD, Utilize Significantly More VA Non-mental Health Medical Services.

Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services Among Returning Iraq and Afghanistan Veterans. 10/04/09. BACKGROUND: Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients' use of non-mental health medical services and the impact of mental disorders on utilization. OBJECTIVE: To compare utilization across three groups of Iraq and Afghanistan veterans: those without mental disorders, those with mental disorders other than PTSD, and those with PTSD. DESIGN AND PARTICIPANTS: National, descriptive study of 249,440 veterans newly utilizing VA healthcare between October 7, 2001 and March 31, 2007, followed until March 31, 2008. MEASUREMENTS: We used ICD9-CM diagnostic codes to classify mental health status. We compared utilization of outpatient non-mental health services, primary care, medical subspecialty, ancillary services, laboratory tests/diagnostic procedures, emergency services, and hospitalizations during veterans' first year in VA care. Results were adjusted for demographics and military service and VA facility characteristics. MAIN RESULTS: Veterans with mental disorders had 42-146% greater utilization than those without mental disorders, depending on the service category (all P < 0.001). Those with PTSD had the highest utilization in all categories: 71-170% greater utilization than those without mental disorders (all P < 0.001). In adjusted analyses, compared with veterans without mental disorders, those with mental disorders other than PTSD had 55% higher utilization of all non-mental health outpatient services; those with PTSD had 91% higher utilization. Female sex and lower rank were also independently associated with greater utilization. CONCLUSIONS: Veterans with mental health diagnoses, particularly PTSD, utilize significantly more VA non-mental health medical services. As more veterans return home, we must ensure resources are allocated to meet their outpatient, inpatient, and emergency needs. Journal of General Internal Medicine via PubMed

Case Management of Older Veterans

Veterans Affairs Intensive Case Management for older veterans. 10/04/09. CONCLUSION: These data highlight the unique characteristics of older veterans receiving assertive community treatment (ACT) type of services and the need to focus greater attention on recovery-oriented services as well as community support for this subgroup. American Journal of Geriatric Psychiatry via PubMed

Sexual Behavior and Sexual Concerns in Women Veterans Treated for PTSD

Sexual Function Outcomes in Women Treated for Posttraumatic Stress Disorder. 10/04/09. Abstract Background: This study examined dysfunctional sexual behavior and sexual concerns in women treated for posttraumatic stress disorder (PTSD). There were three objectives: to characterize the relationship between symptoms of PTSD and sexual outcomes, to examine the effect of treatment on sexual outcomes, and to examine the relationship between change in PTSD and change in sexual outcomes. Methods: Female veterans and active duty personnel with PTSD (n = 242), 93% of whom had experienced sexual trauma, were randomly assigned to receive 10 weekly sessions of either Prolonged Exposure or Present-Centered Therapy. PTSD and sexual outcomes were assessed before and after treatment and then 3 and 6 months later. Results: At baseline, the reexperiencing, numbing, and hyperarousal symptom clusters were related to one or both sexual outcomes. Although prior analyses had shown that Prolonged Exposure resulted in better PTSD outcomes, there were no differences between treatments for either dysfunctional sexual behavior or sexual concerns. However, loss of PTSD diagnosis was associated with improvements in sexual concerns. Conclusions: The findings suggest that clinically meaningful improvements in PTSD are necessary in order to reduce sexual problems in traumatized women. Journal of Women's Health via PubMed

Headaches in Veterans With PTSD and/or Combat Injuries

PTSD, combat injury, and headache in Veterans Returning from Iraq/Afghanistan. 10/04/09. CONCLUSION: Posttraumatic stress disorder and combat-related physical injury were related to higher rates of self-reported headache in newly returning veterans. Our finding that posttraumatic stress disorder and injury during combat are differentially related to migraine and tension-type headache, point to a complex relationship between physical and psychological trauma and headache. These findings have implications for a comprehensive approach to interventions for headache and the physical and psychological sequelae of trauma. Headache via PubMed

Cholinesterase Inhibitors and Incidence of Bradycardia in Veterans With Dementia

Cholinesterase Inhibitors and Incidence of Bradycardia in Patients with Dementia in the Veterans Affairs New England Healthcare System. 10/04/09. CONCLUSION: Using a large cohort, a modestly greater risk of bradycardia was found in patients with dementia taking cholinesterase inhibitors (ChE-Is) than in those not taking these drugs. In patients taking donepezil, the risk of bradycardia may increase with increasing doses. Because of the potential clinical consequences, monitoring for bradycardia may be warranted in patients with dementia treated with ChE-Is. Journal of the American Geriatrics Society via PubMed

Telemedicine vs In-Person Consultation Communication Sytles

An evaluation of patient-physician communication style during telemedicine consultations.(Free full-text) 10/04/09. CONCLUSIONS: The study findings indicate differences between telemedicine (TM) and in-person (IP) consultations in terms of physician-patient communication style. Results suggest that, when comparing TM and IP consultations in terms of physician-patient communication, TM visits are more physician centered, with the physician controlling the dialogue and the patient taking a relatively passive role. Further research is needed to determine whether these differences are significant and whether they have relevance in terms of health outcomes and patient satisfaction with care. Journal of Medical Internet Research via PubMed

Pharmacological Treatment of PTSD

Pharmacotherapy treatment of PTSD and comorbid disorders. 10/04/09. Comorbity is very high in posttraumatic stress disorder (PTSD) patients. PTSD is very often complicated with depressive disorder, substance abuse, other anxiety disorders, personality disorders, psychotic features, etc. There have been few pharmacotherapy studies in this complicated field. In the past few years the literature on pharmacotherapy treatment for PTSD and comorbidity has arisen. From empirical evidence (level A) exist three sertraline studies in PTSD comorbid with: 1) anxiety, 2) depression, and 3) anxiety and depression, and one risperidone study in PTSD comorbid with psychotic symptoms. From empirical evidence (level B) exist two disulfiram, naltrexone, and their combination studies in patients with PTSD comorbid with alcohol dependence and one paroxetine or bupropion versus cognitive behavioral therapy (CBT) versus community mental health referral study in PTSD women outpatients with major depressive disorder. The results from our label trials in the Croatian war veterans with chronic PTSD comorbid with psychotic features treated with novel antipsychotics (olanzapine, risperidone, or quetiapine) are promising. In the future more rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder, especially the trials from level A. Psychiatria Danubina via PubMed

Non-invasive Ventilation Use in VA Hospitals

Noninvasive ventilation for acute respiratory failure: a national survey of veterans affairs hospitals. (Free full-text) 10/04/09. The perception of noninvasive ventilation (NIV) use in the Veterans Affairs hospitals varies significantly. This survey revealed a wide range of training and experience, location of use, presence of written guidelines, and methods of delivery. Notable perceptual differences exist between respiratory therapists and physicians. Underutilization of NIV and low rates of perceived efficacy are major findings. Respiratory Care via PubMed

VAOIG Inspection of Edward Hines Jr. VA Hospital

Healthcare Inspection Alleged Nursing Quality of Care Issues Edward Hines Jr. VA Hospital Hines, Illinois 10/04/09. This purpose of the review was to determine the merit of allegations concerning nursing quality of care involving one nursing unit at the Edward Hines Jr. VA Hospital. Specifically the complainant alleged that: On two occasions, nurses attempted to administer a medication to a patient who was allergic to the medication. A nurse failed to remove a tourniquet from a patient who was diagnosed with dementia. A patient with large wounds on the buttocks was left lying in feces because the nurse called to the bedside said the next shift should clean the patient. We substantiated that nurses attempted to administer a medication to a patient who was allergic to the medication and that a nurse failed to remove a tourniquet from a patient with dementia after drawing blood for testing. We did not substantiate that a nurse left a patient lying in feces or that the nurse told the patient that the next shift should clean the patient. Although we substantiated two of the allegations, we concluded that clinical managers took appropriate administrative actions prior to our review; therefore, we made no recommendations. VAOIG