Background: U.S. Armed Forces members and spouses report increased stress associated with combat deployment. It is unknown, however, whether these deployment stressors lead to increased dependent medication use and health care utilization.
Objective: To determine whether the deployment of Army active duty members (sponsors) is associated with changes in dependent health care utilization.
Design: A quasi-experimental, pre-post study of health care patterns of more than 55,000 nonpregnant spouses and 137,000 children of deployed sponsors and a comparison group of dependents.
Measures: Changes in dependent total utilization in the military health system, and separately in military-provided and purchased care services in the year following the sponsors’ deployment month for office visit services (generalist, specialist); emergency department visits; institutional stays; psychotropic medication (any, antidepressant, antianxiety, antistimulant classes).
Results: Sponsor deployment was associated with net increased use of specialist office visits (relative percent change 4.2% spouses; 8.8% children), antidepressants (6.7% spouses; 17.2% children), and antianxiety medications (14.2% spouses; 10.0% children; P<0.01) adjusting for group differences. Deployment was consistently associated with increased use of purchased care services, partially, or fully offset by decreased use of military treatment facilities.
Conclusions: These results suggest that emotional or behavioral issues are contributing to increased specialist visits and reliance on medications during sponsors’ deployments. A shift to receipt of services from civilian settings raises questions about coordination of care when families temporarily relocate, family preferences, and military provider capacity during deployment phases. Findings have important implications for the military health system and community providers who serve military families, especially those with children.
*Schneider Institute of Health Policy, The Heller School, Brandeis University, Waltham, MA
†Health Program Analysis & Evaluation, TRICARE Management Activity, Department of Defense, Falls Church, VA
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Portions of the results were previously presented at the Academy Health annual meeting in June 2010 in Boston, MA and at the annual Force Health Protection Conference in Phoenix, AZ, in August 2010.
This study was funded under Contract No. HHSP23320045009XI, Task Order No. HHSP233200800001T between U.S. Department of Health and Human Services, Program Support Center as Issuing Office, TRICARE Management Activity (TMA)/Department of Defense as consignee, The CDM Group, Inc. as prime contractor, and Brandeis University as subcontractor. TMA authors provided access to all data files, identified the key research question, requested that the analysis involve the difference-in-differences methodology, and provided critical review of the manuscript for important intellectual content. The analyses were conducted by Brandeis University. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the U.S. Department of Defense. The research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects.
Reprints: Mary Jo Larson, PhD, MPA, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, Waltham, MA 02454-9110. E-mail: firstname.lastname@example.org.