Abstract
The VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides landmark support for family caregivers of post-9/11 veterans. This study examines PCAFC support for veterans with and without PTSD and assesses whether program effect differs by PTSD status using a pre-post, non-equivalent, propensity score weighted comparison group design (n = 24,280). Veterans with and without PTSD in PCAFC accessed more mental health, primary, and specialty care services than weighted comparisons. PCAFC participation had stronger effects on access to primary care for veterans with PTSD than for veterans without PTSD. For veterans with PTSD, PCAFC support might enhance health service use.
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Notes
The term “family caregiver” is used by the PCAFC to designate a veteran-identified family member or friend who supports him/her because he/she is unable to perform activities of daily living or needs supervision and protection due to the residual effects of his/her war-related injuries.
References
Alliance for the Betterment of Citizens with Disabilities. (2016). Supporting family caregiving via the federal waiver. Retrieved from http://www.abcdnj.org/publications/community-based-services/supporting-family-caregiving-via-the-federal-waiver.
Austin, P. C. (2009). Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Statistics in Medicine, 28(25), 3083–3107. https://doi.org/10.1002/sim.3697.
Austin, P. C., & Stuart, E. A. (2015). Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Statistics in Medicine. https://doi.org/10.1002/sim.6607.
Brooks, J. M., & Ohsfeldt, R. L. (2013). Squeezing the balloon: Propensity scores and unmeasured covariate balance. Health Services Research, 48(4), 1487–1507. https://doi.org/10.1111/1475-6773.12020.
Calhoun, P. S., Bosworth, H. B., Grambow, S. C., Dudley, T. K., & Beckham, J. C. (2002). Medical service utilization by veterans seeking help for posttraumatic stress disorder. American Journal of Psychiatry, 159(12), 2081–2086. https://doi.org/10.1176/appi.ajp.159.12.2081.
Crawford, E. F., Elbogen, E. B., Wagner, H. R., Kudler, H., Calhoun, P. S., Brancu, M., & Straits-Troster, K. A. (2015). Surveying treatment preferences in U.S. Iraq-Afghanistan Veterans with PTSD symptoms: A step toward veteran-centered care. Journal of Traumatic Stress, 28(2), 118–126. https://doi.org/10.1002/jts.21993.
Elbogen, E. B., Wagner, H. R., Johnson, S. C., Kinneer, P., Kang, H., Vasterling, J. J., … Beckham, J. C. (2013). Are Iraq and Afghanistan veterans using mental health services? New data from a national random-sample survey. Psychiatric Services, 64(2), 134–141. https://doi.org/10.1176/appi.ps.004792011.
Feinberg, L. F., & Newman, S. L. (2006). Preliminary experiences of the states in implementing the National Family Caregiver Support Program: A 50-state study. Journal of Aging and Social Policy, 18(3–4), 95–113. https://doi.org/10.1300/J031v18n03_07.
Frayne, S. M., Chiu, V. Y., Iqbal, S., Berg, E. A., Laungani, K. J., Cronkite, R. C., … Kimerling, R. (2011). Medical care needs of returning veterans with PTSD: Their other burden. Journal of General Internal Medicine, 26(1), 33–39. https://doi.org/10.1007/s11606-010-1497-4.
Green, K. M., & Stuart, E. A. (2014). Examining moderation analyses in propensity score methods: Application to depression and substance use. Journal of Consulting and Clinical Psychology, 82(5), 773–783. https://doi.org/10.1037/a0036515.
Gros, D. F., Price, M., Yuen, E. K., & Acierno, R. (2013). Predictors of completion of exposure therapy in OEF/OIF veterans with posttraumatic stress disorder. Depression and Anxiety, 30(11), 1107–1113. https://doi.org/10.1002/da.22207.
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2008). Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. U.S. Army Medical Department Journal, 7–17.
Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164(1), 150–153. https://doi.org/10.1176/ajp.2007.164.1.150.
Hundt, N. E., Barrera, T. L., Mott, J. M., Mignogna, J., Yu, H. J., Sansgiry, S., … Cully, J. A. (2014). Predisposing, enabling, and need factors as predictors of low and high psychotherapy utilization in veterans. Psychological Services, 11(3), 281–289. https://doi.org/10.1037/a0036907.
Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., … Foa, E. B. (2010). Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23(6), 663–673. https://doi.org/10.1002/jts.20588.
McCarthy, J. F., & Blow, F. C. (2004). Older patients with serious mental illness: Sensitivity to distance barriers for outpatient care. Medical Care, 42(11), 1073–1080.
Miller, K. M., Kabat, M., Henius, J., & Van Houtven, C. H. (2015). Engaging, supporting, and sustaining the invisible partners in care: Young caregivers of veterans from the post-9/11 era. North Carolina Medical Journal, 76(5), 320–322.
Ouimette, P., Vogt, D., Wade, M., Tirone, V., Greenbaum, M. A., Kimerling, R., … Rosen, C. S. (2011). Perceived barriers to care among veterans health administration patients with posttraumatic stress disorder. Psychological Services, 8(3), 212–223. https://doi.org/10.1037/a0024360.
Possemato, K., Wade, M., Andersen, J., & Ouimette, P. (2010). The impact of PTSD, depression, and substance use disorders in disease burden and health care utilization among OEF/OIF veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 218–223.
Ramchand, R., Tanielian, T., Fisher, M. P., Vaughan, C. A., Trail, T. E., Batka, E., … Ghosh-Dastidar, B. (2014). Hidden heroes: America’s military caregivers. Santa Monica: RAND Corporation.
Rubin, D. B. (1974). Estimating causal effects of treatments in randomized and nonrandomzied studies. Journal of Educational Psychology, 66, 688–701.
Rubin, D. B. (2010). Propensity score methods. American Journal of Ophthalmology, 149(1), 7–9. https://doi.org/10.1016/j.ajo.2009.08.024.
Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, post-tramatic stress disorder, and health outcomes. Advances in Mind-Body Medicine, 20(1), 18–29.
Seal, K. H., Maguen, S., Cohen, B., Gima, K. S., Metzler, T. J., Ren, L., … Marmar, C. R. (2010). VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. Journal of Traumatic Stress, 23(1), 5–16. https://doi.org/10.1002/jts.20493.
Shepherd-Banigan, M., McDuffie, J. R., Shapiro, A., Brancu, M., Sperber, N., Mehta, N. N., … Williams, J. W. J. (2017). Interventions to support caregivers or families of patients with TBI, PTSD, or polytrauma: A systematic review (09 – 001). Retrieved from https://www.hsrd.research.va.gov/publications/esp/reports.cfm.
Spiegelman, D., & Hertzmark, E. (2005). Easy SAS calculations for risk or prevalence ratios and differences. American Journal of Epidemiology, 162(3), 199–200. https://doi.org/10.1093/aje/kwi188.
Spoont, M. R., Nelson, D. B., Murdoch, M., Rector, T., Sayer, N. A., Nugent, S., & Westermeyer, J. (2014). Impact of treatment beliefs and social network encouragement on initiation of care by VA service users with PTSD. Psychiatric Services, 65(5), 654–662. https://doi.org/10.1176/appi.ps.201200324.
Tanielian, T., & Jaycox, L. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Retrieved from http://www.rand.org/pubs/monographs/MG720.html.
Van Houtven, C. H., Smith, V. A., Stechuchak, K. M., Shepherd-Banigan, M., Hastings, S. N., Maciejewski, M. L., … Oddone, E. Z. (2017). Comprehensive support for family caregivers. Medical Care Research and Review. https://doi.org/10.1177/1077558717697015.
Van Houtven, C. H., Voils, C. I., & Weinberger, M. (2011). An organizing framework for informal caregiver interventions: Detailing caregiving activities and caregiver and care recipient outcomes to optimize evaluation efforts. BMC Geriatrics, 11, 77. https://doi.org/10.1186/1471-2318-11-77.
Veterans Health Administration. (2014). Blueprint for excellence. Washington, DC: Veterans Health Administration.
Wagner, T. H., Upadhyay, A., Cowgill, E., Stefos, T., Moran, E., Asch, S. M., & Almenoff, P. (2016). Risk adjustment tools for learning health systems: A comparison of DxCG and CMS-HCC V21. Health Services Research. https://doi.org/10.1111/1475-6773.12454.
Williamson, T., Eliasziw, M., & Fick, G. H. (2013). Log-binomial models: Exploring failed convergence. Emerging Themes in Epidemiology, 10(1), 14. https://doi.org/10.1186/1742-7622-10-14.
Acknowledgements
This project is funded by the Department of Veterans Affairs, Caregiver Support Program, and Quality Enhancement Research Initiative (PEC 14-272) and also received support from the Center of Innovation in Health Services Research in Primary Care (CIN 13-410). Megan Shepherd-Banigan is supported by a VA OAA HSR&D PhD Fellowship TPP 21-000. Dr. Maciejewski reported ownership of Amgen stock due to his spouse’s employment. He has also received funding from the Department of Veteran Affairs HSR&D (CRE 12-306) to test methods for doing heterogeneity treatment effects analysis in three VA trials. The authors have no additional conflicts of interest to disclose. The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Veterans Affairs. The authors gratefully acknowledge the programming assistance of Merritt Schnell and contributions of Drs. Eugene Oddone and Maren Olsen.
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Shepherd-Banigan, M., Smith, V.A., Maciejewski, M.L. et al. The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD). Adm Policy Ment Health 45, 550–564 (2018). https://doi.org/10.1007/s10488-017-0844-8
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DOI: https://doi.org/10.1007/s10488-017-0844-8