Considering the Issue of Dual Use in Veterans Affairs Patients: Implications & Opportunities for Improved Communication & Counseling

Abstract

This study sought to ascertain perceptions of communication responsibility in veterans identified as using more than one health care system, otherwise known as dual users. Three hundred and fifteen veterans identified as dual users completed a telephone-based survey including questions about their perspectives regarding communication in the context of dual use. Nearly half (47.3%) indicated that that they believed it was primarily their responsibility to either directly communicate or facilitate communication between their Veterans Affairs (VA) and non-VA providers. Only 11.3% reported that it should be the responsibility of their VA provider, 19.6% believed that their non-VA provider should be responsible, and 7.3% believed both should be involved. Finally, 14.4% believed another person was responsible, such as a system administrator or patient representative. Of those patients indicating that it was their responsibility, a majority (61.7%) indicated that they preferred active involvement in their health care. Patient-centered care allows patients the opportunity to help facilitate communication between multiple health care systems, such as when using VA and non-VA providers, if they so choose. However, given that patient preferences for involvement vary considerably, it is likely that a multifaceted approach to this problem is necessary, involving patients, providers, and other system-level stakeholders. These data suggest a need to inquire about preferred patient roles and counsel patients regarding methods of communication that may serve to decrease fragmentation of care.

Behavioral Health Screening and Care Coordination for Rural Veterans in a Federally Qualified Health Center

“…4,5 Greater than 60% of rural Americans also live in behavioral health professional shortage areas. 6 Many veterans choose to get some or most of their care in community settings, 7 which has been increasingly a focus in VA the past several years. Examples of expanded access to care in community settings include implementation of VA telehealth programs such as Advancing Telehealth through Local Access Stations (ATLAS) or through legislative acts like the Veterans Choice Act of 2014 or the recently implemented Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018.…”