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Quality of Preventive Medical Care for Patients With Mental Disorders

Druss, Benjamin G. MD, MPH*,†; Rosenheck, Robert A. MD*,†; Desai, Mayur M. PhD, MPH*,†; Perlin, Jonathan B. MD, PhD


Background/Objectives. This study compares quality of preventive services between persons with and without mental/substance use disorders for a national sample of medical outpatients.

Research Design. Cross-sectional study.

Subjects. A total 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. 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.

Results. 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.

Conclusions. 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.

*From the Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut.

From the Yale University Departments of Psychiatry and Public Health, Yale University, West Haven, Connecticut.

From the Veterans Health Administration Office of Quality and Performance, West Haven, Connecticut.

Supported in part by NIMH grant K08-MH01556-01A1.

Address correspondence and reprint requests to: Benjamin G. Druss, MD, MPH, 950 Campbell Avenue/116A, West Haven, CT 06516. E-mail:

Received June 25, 2001; initial decision August 3, 2001; accepted October 3, 2001.

(Med Care 2002;40:129-136)

© 2002 Lippincott Williams & Wilkins, Inc.