US Veterans Who Do and Do Not Utilize Veterans Affairs Health Care Services

Meffert, Brienna N.; Morabito, Danielle M.; Sawicki, Danielle A.; Hausman, Catherine; Southwick, Steven M.; Pietrzak, Robert H.; Heinz, Adrienne J.

doi:10.4088/pcc.18m02350

Cited by 86 publications

(38 citation statements)

References 28 publications

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“…Rates of PTSD are known to be higher in veterans than in the general US population. Furthermore, among veterans, the rates of PTSD are higher in those receiving VA care than those who do not [ 46 ]. Veterans who receive care in the VA are also known to have lower education and income than veterans receiving care outside of the VA.…”

Section: Discussionmentioning

confidence: 99%

A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis

Schapira¹,

Chhatre²,

Prigge³

et al. 2022

JMIR Form Res

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Background Web-based tools developed to facilitate a shared decision-making (SDM) process may facilitate the implementation of lung cancer screening (LCS), an evidence-based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that affect the benefits and potential harms of LCS and thus may value a veteran-centric LCS decision tool (LCSDecTool). Objective This study aims to conduct usability testing of an LCSDecTool designed for veterans receiving care at a Veteran Affairs medical center. Methods Usability testing of the LCSDecTool was conducted in a prototype version (phase 1) and a high-fidelity version (phase 2). A total of 18 veterans and 8 clinicians participated in phase 1, and 43 veterans participated in phase 2. Quantitative outcomes from the users included the System Usability Scale (SUS) and the End User Computing Satisfaction (EUCS) in phase 1 and the SUS, EUCS, and Patient Engagement scale in phase 2. Qualitative data were obtained from observations of user sessions and brief interviews. The results of phase 1 informed the modifications of the prototype for the high-fidelity version. Phase 2 usability testing took place in the context of a pilot hybrid type 1 effectiveness-implementation trial. Results In the phase 1 prototype usability testing, the mean SUS score (potential range: 0-100) was 81.90 (SD 9.80), corresponding to an excellent level of usability. The mean EUCS score (potential range: 1-5) was 4.30 (SD 0.71). In the phase 2 high-fidelity usability testing, the mean SUS score was 65.76 (SD 15.23), corresponding to a good level of usability. The mean EUCS score was 3.91 (SD 0.95); and the mean Patient Engagement scale score (potential range 1 [low] to 5 [high]) was 4.62 (SD 0.67). The median time to completion in minutes was 13 (IQR 10-16). A thematic analysis of user statements documented during phase 2 high-fidelity usability testing identified the following themes: a low baseline level of awareness and knowledge about LCS increased after use of the LCSDecTool; users sought more detailed descriptions about the LCS process; the LCSDecTool was generally easy to use, but specific navigation challenges remained; some users noted difficulty understanding medical terms used in the LCSDecTool; and use of the tool evoked veterans’ struggles with prior attempts at smoking cessation. Conclusions Our findings support the development and use of this eHealth technology in the primary care clinical setting as a way to engage veterans, inform them about a new cancer control screening test, and prepare them to participate in an SDM discussion with their provider.

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Section: Discussionmentioning

confidence: 99%

A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis

Schapira¹,

Chhatre²,

Prigge³

et al. 2022

JMIR Form Res

View full text Add to dashboard Cite

show abstract

“…For example, previous research showed that more than 60% of Medicare eligible older veterans with diabetes received at least some care from non-VHA providers [ 22 ]. The veterans who participated in this study included a relatively large portion of African Americans (48%) as compared to both the overall veteran population who utilize VHA care (about 15%) [ 23 ] and the general Houston population (20%) [ 24 ]. Given the disparities in access to private sector health care faced by people of color, this could have impacted their ability or choice to utilize VHA vs. non-VHA care [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Veterans’ ambulatory care experience during COVID-19: veterans’ access to and satisfaction with primary care early in the pandemic

et al. 2022

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Background The COVID-19 pandemic caused widespread changes to healthcare, but few studies focus on ambulatory care during the early phase of the pandemic. We characterize veterans’ ambulatory care experience, specifically access and satisfaction, early in the pandemic. Methods We employed a semi-structured telephone interview to capture quantitative and qualitative data from patients scheduled with a primary care provider between March 1 – June 30, 2020. Forty veterans were randomly identified at a single large urban Veterans Health Administration (VHA) medical center. The interview guide utilized 56 closed and open-ended questions to characterize veterans’ perceptions of access to and satisfaction with their primary care experience at VHA and non-VHA primary care sources. We also explored the context of veterans' daily lives during the pandemic. We analyzed quantitative data using descriptive statistics and verbatim quotes using a matrix analysis. Results Veterans reported completing more appointments (mean 2.6 (SD 2.2)) than scheduled (mean 2.3 (SD 2.2)) mostly due to same-day or urgent visits, with a shift to telephone (mean 2.1 (SD 2.2)) and video (mean 1.5 (SD 0.6)). Among those who reported decreased access to care early in the pandemic (n = 27 (67%)), 15 (56%) cited administrative barriers (“The phone would hang up on me”) and 9 (33%) reported a lack of provider availability (“They are not reaching out like they used to”). While most veterans (n = 31 (78%)) were highly satisfied with their VHA care (mean score 8.6 (SD 2.0 on a 0–10 scale), 9 (23%) reported a decrease in satisfaction since the pandemic. The six (15%) veterans who utilized non-VHA providers during the period of interest reported, on average, higher satisfaction ratings (mean 9.5 (SD 1.2)). Many veterans reported psychosocial effects such as the worsening of mental health (n = 6 (15%)), anxiety concerning the virus (n = 12 (30%)), and social isolation (n = 8 (20%), “I stay inside and away from people”). Conclusions While the number of encounters reported suggest adequate access and satisfaction, the comments regarding barriers to care suggest that enhanced approaches may be warranted to improve and sustain veteran perceptions of adequate access to and satisfaction with primary care during times of crisis.

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“…First, we examined the overall sample. Then, we stratified by age groups based on prior research that veterans younger than 35 and over 65 are, on average, most likely to use VHA compared to other age groups, 32 which supported three groups: ≤34, 35–64, and ≥65. We also stratified by sex because prior literature illustrates differences in VHA utilization between male and female veterans 33,34 .…”

Section: Methodsmentioning

confidence: 99%

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Hahn

Burkitt

Kauth

et al. 2022

Health Services Research

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Objective This study examined the primary source of health care between veterans with lesbian, gay, bisexual, queer and similar identities (LGBTQ+) and non‐LGBTQ+ veterans. Data Sources and Study Setting Veterans (N = 20,497) from 17 states who completed the CDC's Behavioral Risk Factor Surveillance System from 2016 to 2020, including the Sexual Orientation and Gender Identity and Health Care Access modules. Study Design We used survey‐weighted multiple logistic regression to estimate average marginal effects of the prevalence of utilization of Veteran's Health Administration (VHA)/military health care reported between LGBTQ+ and non‐LGBTQ+ veterans. Prevalence estimates were adjusted for age group, sex, race and ethnicity, marital status, educational attainment, employment status, survey year, and US state. Data Collection Methods Study data were gathered via computer‐assisted telephone interviews with probability‐based samples of adults aged 18 and over. Data are publicly available. Principal Findings Overall, there was not a statistically significant difference in estimated adjusted prevalence of primary use of VHA/military health care between LGBTQ+ and non‐LGBTQ+ veterans (20% vs. 23%, respectively, p = 0.13). When examined by age group, LGBTQ+ veterans aged 34 and younger were significantly less likely to report primary use of VHA/military health care compared to non‐LGBTQ+ veterans (25% vs. 44%, respectively; p = 0.009). Similarly, in sex‐stratified analyses, fewer female LGBTQ+ veterans than female non‐LGBTQ+ veterans reported VHA/military health care as their primary source of care (13% vs. 29%, respectively, p = 0.003). Implications and limitations to these findings are discussed. Conclusions Female and younger LGBTQ+ veterans appear far less likely to use VHA/military for health care compared to their cisgender, heterosexual peers; however, because of small sample sizes, estimates may be imprecise. Future research should corroborate these findings and identify potential reasons for these disparities.

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US Veterans Who Do and Do Not Utilize Veterans Affairs Health Care Services

Cited by 86 publications

References 28 publications

A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis

A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis

Veterans’ ambulatory care experience during COVID-19: veterans’ access to and satisfaction with primary care early in the pandemic

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

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