Quality of Preventive Medical Care for Homeless Veterans with Mental Illness
Benjamin G. Druss Robert A. Rosenheck, Mayur M. Desai and Johnathan B. Perlin
This study compares quality of preventive services between persons with and without mental/substance use disorders for a national sample of medical outpatients. The research design was a cross-sectional study using a sample of 113,505 veterans with chronic conditions and at least three general medical visits to Veterans Health Administration medical providers during 1998 to 1999. Measures included chart‐derived rates of eight preventive services: two measures of immunization, four measures of cancer screening, and two of tobacco screening and counseling. Multivariable‐generalized estimating equations compared rates of each preventive service among veterans with psychiatric disorders, substance use disorders, both, and neither, adjusting for demographic, health status, and facility‐level characteristics. On average, persons in the sample obtained 64% of the eight preventive procedures for which they were eligible. Overall rates of currency with preventive services were 58% for patients with combined psychiatric/substance use disorders, 60% and 65% for those with psychiatric and substance use disorders alone, and 66% for those with neither psychiatric nor substance use disorders. Each difference remained statistically significant in multivariable models. In this sample of patients in active medical treatment, rates of preventive services were higher than rates reported for population‐based, private‐sector samples. Despite these high‐baseline rates, persons with psychiatric disorders, particularly with comorbid substance use, were at risk for lower rate of receipt of preventive services.