Veterans' Location in Health Professional Shortage Areas: Implications for Access to Care and Workforce Supply

Doyle, Jamie Mihoko; Streeter, Robin A.

doi:10.1111/1475-6773.12633

Cited by 17 publications

(15 citation statements)

References 9 publications

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“…The maldistribution of health services, especially subspecialty care, a cross the United States poses a challenge as outsourcing alone is an insufficient solution to improve access. 28 Lastly, the VA’s electronic health record system facilitates continuity between inpatient and outpatient encounters and between primary care and subspecialty care. When care is outsourced, information exchange is often incomplete, continuity is disrupted, and care becomes fragmented.…”

Section: Discussionmentioning

confidence: 99%

Does Community Outsourcing Improve Timeliness of Care for Veterans With Obstructive Sleep Apnea?

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Does Community Outsourcing Improve Timeliness of Care for Veterans With Obstructive Sleep Apnea?

et al. 2020

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“…In part based on the Veterans Choice Act, nearly 1.8 million veterans were authorized by VA to receive care in the community in 2018 alone 13 . The recent 2018 MISSION Act expanded the scope of the Choice program, 14 which may be particularly relevant for rural veterans struggling to access services 15,16 …”

mentioning

confidence: 99%

Veterans Affairs and Rural Community Providers’ Perspectives on Interorganizational Care Coordination: A Qualitative Analysis

Miller

Gurewich

Garvin

et al. 2020

The Journal of Rural Health

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Objective To investigate challenges in care coordination between US Department of Veterans Affairs (VA) clinics and community providers serving rural veterans. Methods We completed qualitative interviews in 2017‐2018 with a geographically diverse sample of 57 VA and community staff. Interviews were audio‐recorded and transcribed verbatim. We used Rapid Qualitative Inquiry (RQI) to guide analyses. Results Results suggested 5 pivotal domains related to interorganizational care coordination at these sites: organizational mechanisms; organizational culture; relational coordination; contextual factors; and the role of the third party administrators charged with management of scheduling and reimbursement of community services through recent legislation. Across these domains, strategies to bridge gaps between organizations (eg, contracts with third party administrators, development of VA‐based community care offices, provision of boundary‐spanning staff) at times exacerbated coordination challenges. Conclusions Steps taken to improve interorganizational care coordination between VA and community clinics may inadvertently complicate an already complex process. Our findings emphasize the importance of attending to key contextual barriers in coordinating care for rural veterans, and they illustrate the value of fundamental structural and relational approaches to enhancing such care coordination.

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“…Our findings provide insight into Veteran preferences for location of care, specifically, the availability of home testing as another reason for preferring VA over community care. In many rural areas, lack of specialists in the community is a known barrier to care [ 31 ]. Among patients who did access community care for testing, lack of follow up and poor continuity of care was an important factor influencing preference for VA, previously identified as a factor influencing satisfaction with outsourced care among both patients and providers [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program

Nicosia

Kaul

Totten

et al. 2021

BMC Health Serv Res

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Background Obstructive sleep apnea is common among rural Veterans, however, access to diagnostic sleep testing, sleep specialists, and treatment devices is limited. To improve access to sleep care, the Veterans Health Administration (VA) implemented a national sleep telemedicine program. The TeleSleep program components included: 1) virtual clinical encounters; 2) home sleep apnea testing; and 3) web application for Veterans and providers to remotely monitor symptoms, sleep quality and use of positive airway pressure (PAP) therapy. This study aimed to identify factors impacting Veteran’s participation, satisfaction and experience with the TeleSleep program as part of a quality improvement initiative. Methods Semi-structured interview questions elicited patient perspectives and preferences regarding accessing and engaging with TeleSleep care. Rapid qualitative and matrix analysis methods for health services research were used to organize and describe the qualitative data. Results Thirty Veterans with obstructive sleep apnea (OSA) recruited from 6 VA telehealth “hubs” participated in interviews. Veterans reported positive experiences with sleep telemedicine, including improvements in sleep quality, other health conditions, and quality of life. Access to care improved as a result of decreased travel burden and ability of both clinicians and Veterans to remotely monitor and track personal sleep data. Overall experiences with telehealth technology were positive. Veterans indicated a strong preference for VA over non-VA community-based sleep care. Patient recommendations for change included improving scheduling, continuity and timeliness of communication, and the equipment refill process. Conclusions The VA TeleSleep program improved patient experiences across multiple aspects of care including a reduction in travel burden, increased access to clinicians and remote monitoring, and patient-reported health and quality of life outcomes, though some communication and continuity challenges remain. Implementing telehealth services may also improve the experiences of patients served by other subspecialties or healthcare systems.

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Veterans' Location in Health Professional Shortage Areas: Implications for Access to Care and Workforce Supply

Cited by 17 publications

References 9 publications

Does Community Outsourcing Improve Timeliness of Care for Veterans With Obstructive Sleep Apnea?

Does Community Outsourcing Improve Timeliness of Care for Veterans With Obstructive Sleep Apnea?

Veterans Affairs and Rural Community Providers’ Perspectives on Interorganizational Care Coordination: A Qualitative Analysis

Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program

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