Review of mental healthcare provision by primary care physicians in the Department of Defense (DoD)

Abstract

Abstract Aim Primary care visits in the United States increasingly involve the treatment of mental health concerns, and the Military Health System (MHS) is no exception. The authors characterize treatment trends of mental healthcare in military primary care. Subject and methods A retrospective analysis of 110 million primary care visits and 27 million behavioral healthcare visits from an MHS database evaluated frequencies and proportions of mental health-related care in both military and civilian healthcare facilities for the years 2017–2021. Prevalence ratios were compared with Poisson regression models by year and by characteristic, with potential linear trends evaluated. Results A notable amount of behavioral healthcare provision transitioned from military to civilian healthcare facilities during this period. A comparison showed that psychotropic medication prescriptions from primary care prescribers with primary care visits coded for psychiatric diagnoses were similar for dependents (16.5% vs. 15.5%) but nearly doubled for military (7.7% vs. 3.9%). Active-duty personnel seen by primary care providers in purchased care (PC) were more than twice as likely to have a behavioral health diagnosis as those seen in direct care (DC) (8.4% vs. 3.9%). Conclusion To the best of the authors’ knowledge, this study is the first to use a comprehensive database to evaluate behavioral healthcare provision trends in the MHS. This provides a baseline of healthcare burden numbers useful for determining the training needed for primary care clinicians to feel comfortable appropriately treating mental health conditions. Future research should focus on diagnostic differences between civilian and military healthcare facilities as well as prescription discrepancies for service members.