3028 — Challenges in Meeting the VA Primary Care Needs of OEF/OIF Veterans
Farmer MM, Rose DE, Rubenstein LV, Canelo I, and Taylor SL, COE Sepulveda; Schectman G, VA Office of Patient Care Services; Stark R, VA Primary Care Operations; Yano EM, COE Sepulveda;
More than 2.2 million US service members have served in Operations Iraqi and Enduring Freedom (OEF/OIF), and some face special post-deployment related physical and psychological health issues. As they enter the VA, it is critical for VA primary care (PC) to identify and manage their complex needs effectively. We sought to describe the presence of designated OEF/OIF PC clinics and examine factors associated with local PC challenges in caring for OEF/OIF Veterans.
In a VA operations/research partnership in 2008-09, we fielded a national web survey to the PC directors of all VAMCs and large CBOCs (n = 229, 92% response rate). Directors were asked about PC arrangements for OEF/OIF Veterans and the degree to which caring for them posed substantial management challenges. We used logistic regression to evaluate predictors of OEF/OIF care delivery as a moderate-to-extreme management challenge.
Over 23% of the sites reported delivery of PC to OEF/OIF patients a moderate-to-extreme management challenge, which did not vary significantly by facility type, size, region or urban/rural location. Sites with fully implemented OEF/OIF-designated clinics were significantly less likely to report moderate-to-extreme management challenges (OR = 0.38, 95%CI: 0.16-0.87). However, only 25% of sites reported having fully implemented designated OEF/OIF clinics and another 18% had only partially implemented them. Of those with partially-or-fully implemented clinics (n = 160), 23% reported that all or almost all OEF/OIF patients visited designated clinics. In contrast, 66% of VA facilities reported that most were seen in general PC clinics.
Almost half of the sites reported implementing designated OEF/OIF clinics in PC. Sites with fully implemented clinics reported fewer challenges. However, less than a quarter of OEF/OIF Veterans were being seen there, leaving the majority of patients in general PC.
General PC clinics continue to deliver most of the PC needs of OEF/OIF Veterans. With the launch of VA Patient Aligned Care Teams (PACTs), special consideration may need to be given with respect to how to adapt PACT arrangements to meet their special needs and coordinate services with designated clinics.