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Ross JS (TREP (Bronx)), Keyhani S
(TREP (Bronx)), Keenan PS
(Yale University), Bernheim SM
(Yale University), Penrod JD
(TREP (Bronx)), Boockvar KS
(TREP (Bronx)), Krumholz HM
(Yale University), Siu AL
(TREP (Bronx))
Objectives:
To examine whether recommended ambulatory service use differs between veterans who receive health care exclusively from the Veterans Affairs (VA) medical system and dual VA users, who use more than one health care system to obtain care.
Methods:
We performed a cross-sectional analysis of data from the 2004 Behavior Risk Factor Surveillance System, a nationally-representative sample of community-dwelling adults. Our main outcome measures were self-reported use of 18 recommended ambulatory services for cancer screening, cardiovascular risk reduction, diabetes management, and infectious disease prevention, defined by age-, sex-, and co-morbid condition-specific national guideline recommendations. We used multivariable logistic regression, adjusting for socio-demographic characteristics, such as income and education, and health care access, such as insurance coverage and personal health care provider identification, to examine the association between exclusive and dual VA use and use of recommended ambulatory services.
Results:
There were 3470 exclusive and 4523 dual VA users. Dual users were significantly more likely to be older, white, college graduates, have higher incomes, and identify a personal health care provider when compared with exclusive users. Use of recommended services varied among the different types of services, but rates were generally high, ranging from 70% reporting influenza vaccination to 95% reporting serum cholesterol screening. In unadjusted analyses, dual users were more likely to report use of 6 of 18 services when compared with exclusive users (P-values = 0.05). After adjustment for socio-demographic and health care access characteristics, utilization was largely similar among exclusive and dual VA users, with no differences in use of 14 of 18 services examined. Exclusive users reported 14% greater use of breast cancer screening and 10% greater use of cholesterol monitoring among patients with hypercholesterolemia, and 6% lower use of prostate cancer screening and 7% lower use of influenza vaccination.
Implications:
Exclusive and dual VA users received similar rates of recommended services.
Impacts:
Differences in recommended ambulatory service use between exclusive and dual VA users were largely accounted for by differences in patient characteristics, such as income and education, suggesting that obtaining health care from both VA and non-VA sources is not by itself associated with greater use of recommended care.
