Importance: Veterans receiving inpatient psychiatric services with occupational performance limitations benefit from occupational therapy, yet facility-level disparities in access to such services have been previously reported in the Veterans Health Administration (VHA). There remains a need to understand explanatory mechanisms underlying the potentially inequitable distribution of such services.
Objective: Elicit in-depth explanations of previously reported quantitative findings regarding facility-level disparities in access to inpatient psychiatric occupational therapy services in the VHA.
Design: Explanatory–sequential mixed methods.
Setting: VHA inpatient psychiatric settings nationally.
Participants: VHA providers and administrators (N = 16) involved in delivering inpatient psychiatric occupational therapy.
Intervention: None.
Outcomes and Measures: Semistructured interviews eliciting explanations for quantitative findings regarding disparities in access to inpatient psychiatric occupational therapy.
Results: Interviews elicited mechanisms explaining the relationship between access to inpatient psychiatric occupational therapy and an indicator of clinical need: activities of daily living limitations (e.g., artificial constraints on occupational therapy’s scope of practice). Interviews also shed light on facility-level disparities in access to inpatient psychiatric occupational therapy by offering explanations for the role of facility characteristics in shaping access, including facility complexity (e.g., staffing), psychiatric care quality (e.g., interdisciplinary care), and bed supply (e.g., staff:patient ratio).
Conclusions and Relevance: This study revealed that facility resources (e.g., staffing levels) and aspects of facility culture (e.g., commitment to interdisciplinary care) may drive variable access to inpatient psychiatric occupational therapy across VHA facilities. The findings can inform the development and evaluation of evidence-based initiatives that improve care quality and Veteran outcomes in this setting.
Plain-Language Summary: Previous research has revealed variable access to inpatient psychiatric occupational therapy services across Veterans Health Administration (VHA) facilities with differing levels of complexity, measured care quality, and bed supply. This study is the first to leverage the perspectives of clinical informants (providers and administrators within the VHA) to elicit explanations for such disparities. These explanations represent modifiable targets that can inform the development of corresponding strategies aimed at achieving equitable access to inpatient psychiatric occupational therapy services in the VHA.
