“Where’s My Choice?” An Examination of Veteran and Provider Experiences With Hepatitis C Treatment Through the Veteran Affairs Choice Program

Abstract

The Choice Program has the potential to increase veteran access to HCV treatment, but veterans and VA providers have described substantial problems in the initial years of the program. Enhancing care coordination, incorporating shared decision-making, and establishing a wide network of community providers may be important areas for further development in designing community-based specialist services for needy veterans.

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

“…In particular, increased fragmentation of care may result in additional challenges for coordination and continuity of care provided . The impact of increased care fragmentation is expected to be more pronounced for Veterans with greater health care utilization, and among them women Veterans, who have additional health burdens and complex care needs …”

“…3 The impact of increased care fragmentation is expected to be more pronounced for Veterans with greater health care utilization, and among them women Veterans, who have additional health burdens and complex care needs. 4,5 Women Veterans (WVs) constitute the fastest growing segment of VA patients, but represent a numerical minority within VA facilities (<10 percent of VA users). 6 Delivering women's health (WH) services, maintaining provider competencies in WH, and providing gender-sensitive care environments have been challenging for VA facilities traditionally oriented toward the care of male patients.…”

Pay-for-Performance and Veteran Care in the VHA and the Community: a Systematic Review

“…We identified five studies examining P4P or related implementation factors in Veteran populations in community settings. [37][38][39][40][41] One study identified published survey instruments examining cross-system access and coordination. 37 Across studies, findings suggest that Veterans, providers, and VHA administrators are concerned that VCP already has and will continue to result in fragmented care, poor communication and coordination among providers, and places an additional burden on and VHA providers and on Veterans.…”

“…37 Across studies, findings suggest that Veterans, providers, and VHA administrators are concerned that VCP already has and will continue to result in fragmented care, poor communication and coordination among providers, and places an additional burden on and VHA providers and on Veterans. 37,40,41 Other concerns include barriers to sharing medical records, [39][40][41] and differences between providers who are interested in VCP participation and those who are not (see online Appendix 12 for detail). 38 Findings from Key Informant Interviews (See Figure 5 for Themes, and Table 3 for Quotes).…”

The role of stigma and trauma in hepatitis C virus treatment in veterans: Applying the common‐sense model

“…Substance use as well as medical comorbidity has also been associated with a lower likelihood of a veteran receiving a prescription for the new DAA medication (Lin et al, ). Additionally, structural factors, such as fragmentation of care and billing issues may affect access to treatment (Tsai et al, ). However, these findings do not represent the full spectrum of challenges faced by veterans with HCV as they make the choice to undergo treatment.…”