TABLE 3.
Comparison of Community Care and Telemental Health Hub consult outcomes
| Outcomes | Veterans Community Care Program consults (N = 207) a Mean (SD) or No. (%) among non‐missing | Clinical Resource Hubs‐Mental Health consults (n = 259) a Mean (SD) or No. (%) among non‐missing | Adjusted difference effect size 95% confidence interval, p‐value |
|---|---|---|---|
| Individual barriers | |||
| Travel a long distance | 25 (12.7%) | 32 (12.5%) | ORCRH‐MH/VCCP = 0.707, CI95 0.381, 1.312, p = 0.270 |
| Inconvenient appointment times b | 28 (14.6%) | 18 (7.3%) | ORCRH‐MH/VCCP = 0.535, CI95 0.286, 1.001, p = 0.050 |
| Appointments too short | 30 (16.6%) | 26 (10.6%) | ORCRH‐MH/VCCP = 0.550, CI95 0.292, 1.035, p = 0.064 |
| Providers not available as soon as needed | 44 (23.0%) | 39 (15.8%) | ORCRH‐MH/VCCP = 0.615, CI95 0.377, 1.004, p = 0.052 |
| Providers lack knowledge of military culture | 45 (27.1%) | 30 (13.4%) | ORCRH‐MH/VCCP = 0.304, CI95 0.177, 0.524, p < 0.001 |
| Lack trust in providers | 37 (19.9%) | 40 (16.1%) | ORCRH‐MH/VCCP = 0.657, CI95 0.388, 1.111, p = 0.117 |
| Stuck in “red tape” or paperwork | 34 (17.3%) | 29 (11.6%) | ORCRH‐MH/VCCP = 0.643, CI95 0.372, 1.112, p = 0.114 |
| Lack of awareness of available services b | 61 (31.1%) | 52 (21.8%) | ORCRH‐MH/VCCP = 0.644, CI95 0.397, 1.044, p = 0.074 |
| Number of barriers endorsed | 1.3 (1.6) | 0.9 (1.3) | IRRCRH‐MH/VCCP = 0.65, CI95 = 0.51, 0.83, p < 0.001 |
| Service utilization | |||
| Any encounters | 155 (75.2%) | 211 (82.1%) | ORCRH‐MH/VCCP = 1.241, CI95 0.747, 2.063, p = 0.404 |
| Number of encounters | 6.2 (6.8) | 5.9 (7.3) | βCRH‐MH‐VCCP = ‐0.792, CI95‐2.221, 0.636, p = 0.276 |
| Patient centeredness | N = 155 | N = 211 | |
| Patient centered satisfaction survey score | 4.2 (0.7) | 4.3 (0.6) | βCRH‐MH‐VCCP = 0.155, CI95−0.107, 0.417, p = 0.243 |
| Clinical outcomes | |||
| ΔPHQ‐8 | −2.2 (5.3) | −1.2 (4.9) | βCRH‐MH‐VCCP = 1.413, CI95 0.321, 2.505, P = 0.011 |
| ΔPCL‐5 | −6.0 (12.6) | −3.4 (12.5) | βCRH‐MH‐VCCP = 2.980, CI95−1.071, 7.031, p = 0.148 |
Abbreviations: CI95, 95% confidence interval; IRRCRH‐MH‐VCCP, incidence rate ratio, the ratio of the number of events for Clinical Resource Hubs‐Mental Health and Veterans Community Care Program; ORCRH‐MH‐VCCP, odds ratio, odds of observing outcome in Clinical Resource Hubs‐Mental Health compared to Veterans Community Care Program; βCRH‐MH‐CC, difference in scale's units between Clinical Resource Hubs‐Mental Health and Veterans Community Care Program; Δ, Change in; ΔPCL‐5, change in 20‐item Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5); ΔPHQ‐8, change in 8‐item Patient Health Questionnaire (excludes question about suicide ideation).
Sub‐sample with completed 4‐month follow‐up surveys.
Reverse scored.