Understanding Primary Care Behavioral Health Across Military Settings: A Preliminary Comparison Between Deployed and In-Garrison Care

摘要

Background: Integrated primary care behavioral health (PCBH) is a growing trend in health care delivery, particularly in the Department of Defense and the Department of Veterans Affairs. This consultative model has been applied within the U.S. Air Force for over 15 years and has demonstrated positive health impacts and patient satisfaction. With extended conflicts and engagements, including Operation Enduring Freedom and Operation Iraqi Freedom, deployment behavioral health care has expanded and positively received, but there is less empirical support of particular models of care in a deployed environment. Brief, solution-focused strategies commonly utilized in PCBH are likely to be particularly good candidates for the deployed environment. One key feature the Air Force's PCBH program is the collaborative team-based approach to care centered around a patient and driven by a primary care manager. This study expands the evaluation of the Air Force's PCBH program to include its novel application in a combat setting. Method: A retrospective review of 516 archival patient satisfaction surveys across Air Force military treatment facilities utilizing a PCBH program compared patient satisfaction surveys collected in a deployed environment at a large combat support hospital to noncombat facilities. Findings: Results indicated that patient satisfaction in theater was comparable to satisfaction at Air Force military treatment facilities in noncombat environments, with one exception; patients seen in garrison rated higher satisfaction with the treatment plan than those seen in a deployed setting, F(509) = 5.36, p < 0.01, consistent with limited resources available in theater. Discussion: Given patient satisfaction across settings was found to be relatively equivalent, results suggests that the PCBH consultation model may be an appropriate model of care to meet a majority of the population's needs for a deployed environment. This pilot study has implications not only for military combat environments, but other austere settings, including civilian rural mental health settings. These findings inform provision of care in a deployed environment by demonstrating the benefits of the primary care behavioral model. Additionally, the Department of Veterans Affairs and other federal health care agencies will benefit from reviewing the structured and standardized PCBH model employed by the U.S. Air Force for nearly two decades as they expand care in rural mental health settings across the country.