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APHA Scientific Session and Event Listing

Greg Greenberg, NEPEC - VA Northeast Program Evaluation Center, Yale, 950 Campbell Ave, West Haven, CT 06511, 203-645-9789, greg.greenberg@yale.edu and Robert A. Rosenheck, MD, Department of Psychiatry, Yale University, VA Connecticut Healthcare System, 950 Campbell Avenue, NEPEC (182), West Haven, CT 06516.

Objective: Advanced practice nurses (APNs), including clinical nurse specialists and nurse practitioners now have prescribing privileges in all states. This study examined the proportion of Department of Veteran Affairs (VA) mental health patients who were seen by any prescribing professional, and specifically the proportion and characteristics of patients who were treated exclusively by APNs.

Method: Logistic regression models were used to examine data on all patients who received care in VA specialty mental health clinics in 2002 (n=767,920). We first identified patient characteristics independently associated with prescriber contact and secondly, among those with prescriber contact, exclusive contact with an APN. We also compared characteristics of patients seen exclusively by an APN with those who saw both a physician and an APN.

Results: The strongest predictors of both whether a veteran saw a prescriber (66.6%), and whether that prescriber was exclusively an APN (6.7%) were indicators of severity. Specifically, more severe diagnoses, such as schizophrenia or bipolar disorder, receipt of VA disability payments and greater service use increased the odds that a veteran would have had a prescriber contact, decreased the odds that they would see an APN exclusively, and among those who saw an APN increased the odds that they would also see a physician.

Conclusions: Patients who see physician prescribers have more severe mental health problems than those who see APRNs. APRNs do not appear to substitute for physicians.

Learning Objectives:

• • At the end of the session, the participant will understand what factors are associated with access to different types of prescribing professionals by individuals receiving mental health services.

Keywords: Mental Health, Access and Services

Presenting author's disclosure statement:

Not Answered