RESUMO
CONTEXT: Dialectical Behavior Therapy (DBT) is an evidence-based therapy developed for the treatment of suicidal behaviors and disorders characterized by emotional and behavioral dyscontrol that is effective in veteran populations. The impact of DBT on veterans' Veterans Affairs (VA) service utilization and cost is unknown. EVIDENCE ACQUISITION: This study evaluated the impact of DBT in a VA outpatient mental health setting on VA service utilization and cost of services. Veterans treated for symptoms of Borderline Personality Disorder, who had completed at least 6 months of the DBT program were sampled (N = 41). Use of physical and mental health services during the years prior and following DBT was assessed using medical record information. RESULTS: There was a significant decrease in mental health service utilization. Psychiatric hospitalization dropped in half, and for those with a hospitalization, length of stay decreased significantly. Direct costs associated with all health care were significantly reduced. CONCLUSION: Changes in service utilization resulted in a significant reduction in direct costs of providing care to veterans with symptoms of Borderline Personality Disorder. Additional research is needed to compare the reduction in overall costs to the cost of implementing DBT and to compare these changes to a control group.
Assuntos
Terapia Comportamental , Transtorno da Personalidade Borderline/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Prevenção do Suicídio , Veteranos , Adulto , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Transtorno da Personalidade Borderline/economia , Depressão/terapia , Custos Diretos de Serviços , Transtorno Distímico/terapia , Prática Clínica Baseada em Evidências , Feminino , Seguimentos , Custos de Cuidados de Saúde , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitais Psiquiátricos/economia , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Masculino , Serviços de Saúde Mental/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Suicídio/economia , Suicídio/psicologia , Estados Unidos , United States Department of Veterans Affairs/economia , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/psicologiaRESUMO
This study evaluated the impact of a course of prolonged exposure or cognitive processing therapy on mental health and medical service utilization and health care service costs provided by the Department of Veterans Affairs (VA). Data on VA health service utilization and health care costs were obtained from national VA databases for 70 veterans who completed prolonged exposure or cognitive processing therapy at a Midwestern VA medical center. Utilization of services and cost data were examined for the year before and after treatment. Results demonstrated a significant decrease in the use of individual and group psychotherapy. Direct costs associated with mental health care decreased by 39.4%. Primary care and emergency department services remained unchanged.