Perceptions of quality of health care among veterans with psychiatric disorders

Objective: An estimated 37% to 40% of veterans treated by the U.S. Department of Veterans Affairs (VA) have a psychiatric disorder, and many of them have comorbid general medical problems. This study examined the impact of demographic and clinical characteristics on perceptions of outpatient health care experiences among veterans with psychiatric disorders. Methods: Responses from the Survey of Health Care Experiences (SHEP) administered by the Veterans Health Administration (VHA) and administrative data from the VA were collected for 55,578 patients aged 18 and older with a psychiatric disorder surveyed in fiscal year 2005. Bivariate and multivariable analyses were used to examine the associations between demographic and clinical characteristics and patients' responses about providers' attentiveness, collaboration in health care decisions, confidence in providers, and overall quality of care. Results: Most veterans with psychiatric disorders perceived their health care experiences positively. However, those who were younger, were nonwhite, had lower incomes, had a service-connected disability, and had been diagnosed as having PTSD or a substance use disorder were less likely to perceive their health care experiences positively. Conclusions: An opportunity exists to improve clinical practice and design health care services to better serve certain groups of patients at VHA facilities. Areas of improvement may include rapport building and developing ways to include patients in decisions about their health care.