Research Questions Do service members with PTSD, depression, or substance use disorder who reside remotely from a military treatment facility have similar access to care through the MHS as non-remote service members? What is the quality of care for service members with PTSD, depression, or substance use disorder, and does quality differ between remote and non-remote service members? What changes can the MHS make to ensure access to high-quality behavioral health care for service members, regardless of their remote status?
Geographic location can be a barrier to accessing and receiving high-quality behavioral health care for both civilians and military personnel. As a consequence, service members who reside far from military treatment facilities may be at higher risk for poorer clinical outcomes than those who are less remotely located.
The authors evaluate remote service members' access to Military Health System (MHS) care for those with posttraumatic stress disorder (PTSD), depression, or substance use disorder (SUD) and assess the quality of the behavioral health care they received. The report highlights how quality-measure performance varies by remote status, focusing on differences in quality of care that are large and potentially clinically significant. The authors also discuss policy implications and offer recommendations for how the military can use new strategies — including synchronous telehealth or technology-enabled interventions — to ensure access to high-quality care for all service members, regardless of location.
Key Findings Remote service members — who were more likely to be White, Army, and senior enlisted — received more of their behavioral health care from primary care providers and from the private sector, and they were less likely to receive psychotherapy. For appointments at military treatment facilities, remote service members had shorter average wait times than non-remote service members for routine and specialty direct care. Few service members (less than 3 percent) received synchronous (i.e., real-time) telehealth at a military treatment facility, and fewer remote service members received synchronous telehealth than non-remote service members. Remote service members were less likely to receive psychotherapy or other psychosocial interventions, and they were less likely to receive at least a minimally adequate amount of initial care when starting a new episode of treatment for PTSD or depression. Rates of adequate duration of medication were similar for remote and non-remote service members, but remote service members were often less likely to receive timely follow-up after initiation of medication treatment. Remote service members were less likely to receive a timely outpatient follow-up visit following discharge from a mental health hospitalization or emergency department visit. Overall, the MHS showed strong performance on duration of pharmacotherapy and follow-up after mental health hospitalization or emergency department visit, but performance was lower for other measures.
Recommendations Reduce differences in quality of care for remote service members with behavioral health conditions: Increase receipt of psychotherapy/psychosocial interventions for remote service members; improve timely follow-up after psychiatric hospitalization and mental health emergency department visits for remote service members; and improve rates of follow-up for remote service members after initiating medication treatment. Implement effective strategies, including telehealth, to meet the behavioral health needs of remote service members. Enhance approaches to monitoring access to behavioral health services for remote service members from private sector care providers. Create a learning behavioral health care system to improve the quality of behavioral health care for all beneficiaries served by the MHS. Identify drivers of observed differences in behavioral health care for remote and non-remote service members.
Related Products
News Release
Geographic Barriers to Behavioral Health Care May Put Remote Service Members at Risk Mar 31, 2021
Table of Contents Chapter One
Introduction
Chapter Two
Methods
Chapter Three
Remote Versus Non-Remote Differences in Demographics and Behavioral Health Care Utilization
Chapter Four
Access to Direct Care for the Behavioral Health Cohort
Chapter Five
Quality of Behavioral Health Care: Initial Care
Chapter Six
Quality of Behavioral Health Care: Medication Management
Chapter Seven
Quality of Behavioral Health Care: Transitions of Care
Chapter Eight
Summary and Recommendations
Appendix A
Sensitivity Analyses of Remoteness Definition
Appendix B
Technical Specifications for Access and Behavioral Health Quality of Care Measures
Appendix C
PTSD, Depression, and SUD Cohort Demographic and Service Characteristics
Appendix D
Cohort Descriptive Data by Diagnostic Cohort
Appendix E
Summary of Remote Versus Non-Remote Differences in Behavioral Health Quality Measures
Research conducted by RAND National Security Research Division
This research was sponsored by the Defense Health Agency and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute.
This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.
Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.