2012 National Meeting

1049 — Veterans’ Perspectives on Using Both VA and Non-VA System Care

Hung WWMoodhe NDunn CMorano BGottesman EGrier S, and Boockvar KS, JJP VAMC;

To identify patterns of healthcare use among older Veterans who utilize both VA medical centers and non-VA facilities for healthcare and reasons behind using both systems.

Veterans were identified from primary care or geriatrics primary care clinic at an urban tertiary VAMC and were included if they were aged 65 or above, utilized non-VA healthcare services in the 2 years prior, and had a match in the Bronx Regional Health Information Organization, a community-wide electronic medical record. Patients were interviewed using a structured instrument based on the Primary Care Assessment Survey to assess reasons for using both VA and non-VA care, and on patterns of non-VA healthcare use in the previous 2 years including hospitalization, emergency visits, and other outpatient visits. Patients' VA pattern of use was assessed from medical record review.

94 male Veterans, mean age 80.8 (SD 6.9), completed the survey. Among them, 38% were white, 38% black, and 21% Hispanic; 32% did not complete high school. 38% reported that they did not have a regular non-VA provider. 76% had non-VA outpatient visits and 54% reported non-VA hospitalizations. Most frequently cited reasons for non-VA use were convenience of location (34%), ability to get referred to a specialist (26%), and usual wait time for appointment when sick (23%); whereas most frequently cited reasons for VA use were ability to get medications (65%) and other prescribed treatments such as a cane (60%), ability to get referred to a specialist (40%) and provider’s caring and concern (39%).

Among older Veterans who utilized both VA and non-VA healthcare facilities, perceived provider knowledge, caring and concern, and trust in provider judgment were not the major drivers for use of non-VA care. Access to care including convenience of location and wait time is a major reason for non-VA use.

In an increasingly competitive environment of competing healthcare systems, VHA needs to continue to improve access for Veterans who have a choice of VA or non-VA care. Developing coordination strategies between VA and non-VA systems that take into account patterns of non-VA system use and Veterans' needs are necessary to provide optimal care.