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;

Objectives:
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.

Methods:
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.

Results:
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%).

Implications:
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.

Impacts:
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.