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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1086 — Community, Institutional, and Individual Issues and Access to Care among Rural and Urban Veterans of Operation Enduring Freedom/Iraqi Freedom/New Dawn

Whealin JMBozik-Lyman SC, and Nelson DD, NC-PTSD; Stotzer R, University of Hawaii; Vogt D, NC-PTSD, Boston University; Pietrzak R, and Southwick S, NC-PTSD, Yale University;

Objectives:
Research has shown that Veterans of Operation Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) under-utilize mental health services. Additionally, over 40% of the current OEF/OIF/OND Veterans are from rural areas, which can present additional access to care difficulties. This presentation will provide an overview of barriers to obtaining mental health care for rural and urban OEF/OIF/OND Veterans for an audience of VA researchers, administrators, and healthcare providers.

Methods:
Mailed surveys were evaluated from 117 rural and 116 urban Veterans (58% response rate) randomly selected from the VA Pacific Islands OEF/OIF Veterans Care Registry.

Results:
Rural and urban Veterans were similar demographically, except that rural Veterans had lower household income [chi-squared (1, N = 219) = 6.710, p = .010] and education [chi-squared (1, N = 232) = 10.2, p <.001] compared to urban Veterans. Among Veterans who reported wanting help for a mental health issue, rural and urban Veterans reported comparable use of VA clinics (for both medications and psychotherapy), private/community clinics, self-help groups, and spiritual leaders/traditional healers. However, rural Veterans reported significantly more use of Vet Centers when compared to urban Veterans [chi-squared (1, N = 90) = 8.009, p <.05]. VA was identified as a preferred source for services by 43.8% of Veterans. Other preferred sources included military resources, family/peers, private healthcare, and religious/spiritual institutions. Finally, items assessed “what it would take” for Veterans who have never used VA to use it now. Responses fell into three broad categories related to removal of barriers at the level of the individual, institution, and community.

Implications:
Quantitative results indicate that while rurality did not predict service use, it may influence the type/source of services a Veteran seeks. Qualitative responses indicated a continued need for education and outreach to 1) help Veterans overcome individual obstacles, 2) change institutional culture and procedures, and 3) address stigma in the community and system.

Impacts:
Documenting VA and non-VA service access and preferences among new rural and urban Veterans can help inform VA policy and outreach efforts. Additionally, the education and outreach strategies identified in this work provide unique opportunities for VA to improve access to and management of its health service administration.


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