EMERGING EVIDENCE
Emerging Evidence periodically presents results on a single subject gleaned from the Final Reports of completed HSR&D studies focusing on a specific topic of interest. The information presented in Emerging Evidence is for consideration and review only. Results and authors' recommendations do not represent formal or recommended VA policy. Results of the studies presented may not have undergone full peer review.
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Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF)
As our Veterans return from deployments to Afghanistan and Iraq, they face health issues that are unlike those facing Veterans in previous conflicts. Rates of post-traumatic stress disorder, traumatic brain injury, and other trauma resulting from improvised explosive devices appear to be higher in this population than among Veterans from previous conflicts. As a result, research that addresses the broad spectrum of concerns facing OEF/OIF Veterans has taken on increasing urgency.
Emerging Evidence presents five recently completed studies that look at a variety of issues affecting OEF/OIF Veterans.
Keywords: Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), community reintegration, access, mental health, TBI, treatment preferences, caregivers, polytrauma, PTSD
Overall Geographic Access to Polytrauma Care is High
- Median distances to Level I, Level II, and Level III facilities were 411 miles, 121 miles, and 64 miles respectively.
- The median distance to the closest VA facility of any kind was 22 miles.
- Overall, the VHA Polytrauma System of Care provided reasonable rehabilitation access to 87.1% of inpatient and 88.3% of outpatient users of VHA services for the combined FY03-FY04 cohort.
- For each mile a Veteran is closer to a Level II polytrauma center, the odds of receiving rehabilitation services are increased by 1%.
OEF/OIF Veterans Face Multiple Concerns with Community Reintegration
- Reintegration problems took the form of anger control, productivity issues, social relations, and increases in harmful behaviors (alcohol and substance use).
- Ninety-six percent of the Veterans in this study who use VA healthcare would be interested in services for community reintegration problems.
- The most popular forms of receiving information were through VA, over the Internet, and through the mail.
- Of the estimated 41% of those with probably PTSD, each type of reintegration problem reported as more prevalent.
OEF/OIF Veterans' Mental Health Has Significant Impact on Their Caregivers
- Health related quality of life
- Mental health (depression and suicidal ideation)
- Substance use (alcohol, prescription medications, illicit drugs)
- Burden of care
- Conflict (marital, parent-child)
Web-based Treatment Prototype Shows Promise For Mild TBI
- Overall satisfaction with the prototype website was high, with patients rating the usefulness, quality, interactive nature, and format as "good to high."
- Over 50% said that they would definitely use the website if it were available.
- Participants would like to see more information that's interactive, and more information about injuries sustained from IED (improvised explosive device) blasts.
- Participants believe that adding coping skills and exercises to improve memory, as well exercises that involve caretakers would be beneficial.
Tracking the Transition of Veterans' Health Information from DoD to VA Requires Personal and Electronic Approaches
- PHI transfer from Brooke Army Medical Center (BAMC) to South Texas VHCS was feasible using only person-to-person contact.
- Electronic records transfer would likely be more efficient and secure than only person-to-person contact.
- Success was enhanced by the creation of a straightforward transition protocol for both research and clinical medical data exchange.
- Among transitioned Veterans, 40% used VHA care within 6 months of discharge of BAMC, and 77% used VHA care within one year, which would suggest that tracking PHI over the long-term tracking is actually of greater import than short-term.
- In adjusted analysis, longer time to transition to VHA care was associated with wounded-in-action status, while shorter time was associated with burn injuries.
- Psychiatric diagnosis in the DoD medical system was not related to length of time to transition to VHA.
Completed in September 2007, this study examined the relationship between access to critical rehabilitation services and geographic location among a cohort of approximately 7,800 OEF/OIF Veterans. (Study No.: DHI 06-010. PI: Diane C. Cowper Ripley, PhD)
Implications
Rehabilitation services are especially important in the VA today, given the unique kinds of trauma impacting OEF/OIF Veterans. Overall, the Polytrauma System of Care provides reasonable access to care; however, the authors suggest that new specialized rehabilitation resources be located where they provide the largest impact in terms of fulfilling unmet needs, and recommend that VA may look more closely at locating new facilities within the 10 U.S. counties identified in the study as potentially underserved.
Completed in September 2008, this study sought to examine and describe the prevalence and types of community reintegration problems that OEF/OIF Veterans experience, and to identify their interests in types of interventions that will help them address those concerns. (Study No.: RRP 07-315. PI: Nina A. Sayer, PhD.)
Implications
Based on this study, the authors suggest that one-half of the population of Veterans of the OEF/OIF conflicts is struggling with community reintegration problems, and they face challenges in many areas of functioning. These Veterans are most interested in interventions or information to help them adjust to community life. Further, women Veterans were more interested in a greater variety of services than their male counterparts, and services such as self-help techniques (yoga, meditation) were of particular interest. The authors also noted that those with probable PTSD faced stigma-related barriers to seeking treatment, and recommend that this be an area of continued research.
Completed in December 2008, this research project focused on establishing, for use in future studies, a battery of instruments that can be used to assess the impact of OEF/OIF Veterans' mental health on caregivers. (Study No.:SHP 080-170. PI: Jeanne Hayes, PhD, MPA.)
Implications
Although within the five domains examined, the authors gained a better understanding of the difficulties facing caregivers of OEF/OIF Veterans with PTSD, they believe that considerable need still exists to further investigate the impact of Veterans' emotional trauma on this group. Further, the authors suggest that future research efforts include identifying barriers to care for OEF/OIF/Veterans, spouses, and families.
This study was completed in September 2008 and shows significant promise for the prototype of a psychoeducational website designed to treat Veterans diagnosed with mild traumatic brain injury (TBI). (Study No.: SHP 08-189. PI: Audrey L. Nelson, PhD, RN)
Implications
The authors are in the process of developing a fully-functioning website that will incorporate more combat-related information. The live site will incorporate practical tips for condition management, as well as be interactive and dynamic. This prototype offers positive indications that the Internet is a valid, cost-effective way to provide psychoeducational interventions for Veterans with mild TBI.
Completed in September 2008, this study examines the transition process for protected health information (PHI) as Veterans move from care in the Department of Defense (DoD) Army medical system to care in the Veterans Health Administration (VHA). (Study No.: SHP 08-140. PI: Laurel Copeland, PhD.)
Implications
The authors' data supports the development of a conduit for electronic connection between DoD medical treatment facilities' research servers and VHA research servers so as to enable the direct electronic transfer of PHI for future use in research and immediate use in clinical care.