49. Veterans' Attitudes Toward Increased Non-Physician Provider Care in a Variety of Service Delivery Contexts and Some Associated Variables
TR Anderson, Houston VAMC, Baylor College of Medicine; SE Dierker, Houston VAMC; JA Boeringa, Houston VAMC, Baylor College of Medicine; J Thornby, Houston VAMC, Baylor College of Medicine
Objectives: 1. To assess veterans' attitudes regarding more Non-Physician Provider (NPP) involvement in their health care in different contexts.
2. To assess self-rated and objective knowlege of NPP groups.
3. To assess paired care enhancement(e.g. faster access) effects on consumer comfort level.
4. To identify patient differences(e.g. demographic attributes, NPP knowlege, quantity/guality of prior NPP experience) associated with veteran comfort with more NPP care.
5. To offer a first scale in this area for refinement and eventual validation.
Methods: A 34 item questionnaire was created (necessarily) de novo to assess relevant patient variables (e.g. attitudes, knowlege and prior experiences) related to NPP's. One hundred questionnaires were placed in 11 selected clinics affiliated with the Houston VAMC. A standardized data collection format was followed. Five hundred and forty two respondents returned questionnaires. Levels of comfort were assessed in fifteen distinct care contexts with a four point Likert-type scale. Results were examined using simple frequency data, Analysis of variance and T tests between groups,multiple regression analyses, Cronbach's Alpha and factor analytic procedures.
Results: Results indicated a stronger than expected and broad level of discomfort with increased NPP involvement in health care. Paired enhancements (e.g. a promised care "coordinator") increased acceptance. Younger veterans, those with more and better NPP experiences, and veterans receiving mental health services at the time of data collection had significantly greater comfort with more NPP care. Tested knowlege of NPP groups was lower than self-rated knowlege. Knowlege of the most highly trained nursing group was quite low. Factor analytic results suggested refinement and shortening of the scale.
Conclusions: The veterans surveyed in this study rated themselves as frankly uncomfortable with the prospect of more NPP involvement in their health care. Resistance to expanding NPP roles in health care appears quite strong in this population. Knowlege of NPP groups (and especially the highest trained nursing group) was low. Planned educational interventions, positive treatment experiences with NPP's and paired enhancements of care are recommended to increase consumer confidence in and cooperation with any appropriate future increases in NPP involvement in health care.
Impact: Veterans' attitudes about expanding roles of Non-Physician Providers in health care were assessed. Discomfort with the notion of increased NPP involvement in care was found to be relatively strong. Awareness of the level of patient discomfort in this area seems important for all those involved in health care service delivery and planning. Educational interventions are recommended to realistically impact consumers' attitudes toward and acceptance of appropriately expanded roles for NPP's.