Perceptions of Physicians in Civilian Medical Practice on Veterans’ Issues Related to Health Care

Fredricks, Todd R.; Nakazawa, Masato

doi:10.7556/jaoa.2015.076

Cited by 19 publications

(16 citation statements)

References 20 publications

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“…The increase in care fragmentation associated with more referrals to non-VA care may affect other aspects of care that are valued by WVs, such as their relationship with their VA PC providers, coordination of care, and receipt of care from providers experienced in caring for Veteran-specific issues. [35][36][37] Our findings point to provider communication and gender sensitivity as essential drivers of how patients view their care.…”

Section: Discussionmentioning

confidence: 72%

“…While VA has sought greater oversight over the coordination of care between VA and community settings, how this coordination will be achieved and whether it will be tailored to WVs’ needs are still unknown. The increase in care fragmentation associated with more referrals to non‐VA care may affect other aspects of care that are valued by WVs, such as their relationship with their VA PC providers, coordination of care, and receipt of care from providers experienced in caring for Veteran‐specific issues …”

Section: Discussionmentioning

confidence: 99%

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Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans’ experience with VA care

Chanfreau‐Coffinier

Washington

Chuang

et al. 2019

Health Services Research

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Objective To examine the relationship between care fragmentation and patient ratings of care quality and identify potentially actionable mediators. Data Sources/Study Setting 2015 telephone survey of 1395 women Veterans with three or more visits in primary care and/or women's health care in the prior year at 12 Veterans Affairs (VA) medical centers. Study Design Cross‐sectional analysis. Data Collection/Extraction Methods We operationalized lower care fragmentation as receiving VA‐only care versus dual use of VA/non‐VA care. Participants rated VA care quality (overall care, women's health care (WH), and primary care (PC)) and three aspects of their patient experience (ease of access to services, provider communication, and gender sensitivity of VA environments). We examined associations between care fragmentation and care ratings and applied the Karlson‐Holm‐Breen decomposition method to test for mediation by aspects of patients’ experience. Principal Findings Lower care fragmentation was associated with higher ratings of care quality (odds ratios [95% CI] for overall care: 1.57 [1.14;2.17]; WH: 1.65 [1.20;2.27]; PC: 1.41 [1.10;1.82]). Relationships were mediated by patient‐rated provider communication and gender sensitivity (26‐54 percent and 14‐15 percent of total effects, respectively). Ease of access was associated with higher care ratings (odds ratios [95% CI] for overall care: 2.93 [2.25;3.81]; WH: 2.81 [2.15;3.68]; PC: 2.33 [1.63;3.33], in models with the three types of patient care experiences included), but did not mediate the association of care fragmentation and care ratings. Conclusions Potential negative effects of care fragmentation on care quality ratings could be mitigated by attention to quality of patient‐provider communication and gender sensitivity of VA environments.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans’ experience with VA care

Chanfreau‐Coffinier

Washington

Chuang

et al. 2019

Health Services Research

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“…15 One study assessed community primary care providers’ perceptions and comfort with veterans’ healthcare problems, and found low comfort in addressing common issues. 16…”

Section: Introductionmentioning

confidence: 99%

Addressing Patients’ Veteran Status: Primary Care Providers’ Knowledge, Comfort, and Educational Needs

Vest

Kulak

Hall

et al. 2018

Fam Med

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Our pilot results demonstrate that in a regional sample of primary care providers, providers rarely ask patients about their military history; however, they feel it is important information for patient care. While further study is needed, it may be necessary to provide education, specifically pertaining to military culture and health-related sequelae, to address barriers that may be limiting PCPs' provision of care for this population.

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“…However, based on published literature we can speculate that there is a knowledge gap in this area. For example, Fredricks and Nakazawa surveyed physicians (the majority were in primary care or internal medicine) to assess civilian physician knowledge of Veterans’ issues. The authors reported that despite providing care for a high percentage of Veterans, the physician participants recognized the need for more training on Veteran‐specific healthcare issues.…”

Section: Discussionmentioning

confidence: 99%

Five‐year trend in healthcare access and patient‐reported health outcomes among women veterans

2019

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Background: This study aimed to describe the five-year trend in healthcare access, health-related quality of life (HRQoL), and health outcomes in women Veterans.Methods: A retrospective, pooled, cross-sectional study design was employed. Fiveyear trend was assessed using 2013 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) data. Bivariate, multivariable logistic regression, and ordinary least squares regression analyses were conducted.Results: A total of 6561 women Veterans, aged 18 to 64 years (3534 in 2013 and 3027 in 2017) were included. Compared to 2013, more women Veterans in 2017 reported increased healthcare insurance and decreased cost as a barrier to care.Women Veterans with health insurance were less likely to report cost as a barrier to care. There were no statistically significant differences in HRQoL in bivariate or ordinary least squares regression analyses between BRFSS years. Conclusion: Federal policy and Veterans Health Administration expansion have hadan impact on improving healthcare access to women Veterans. However, increased healthcare access alone does not translate into improved HRQoL or health outcomes for women Veterans. Future policies should not only focus on increasing healthcare access, but also improving health outcomes, especially HRQoL. The quality of the healthcare accessed must be a focus for future research and policy. K E Y W O R D Shealth insurance, HRQoL, trend, women Veterans

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Perceptions of Physicians in Civilian Medical Practice on Veterans’ Issues Related to Health Care

Cited by 19 publications

References 20 publications

Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans’ experience with VA care

Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans’ experience with VA care

Addressing Patients’ Veteran Status: Primary Care Providers’ Knowledge, Comfort, and Educational Needs

Five‐year trend in healthcare access and patient‐reported health outcomes among women veterans

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