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2019 HSR&D/QUERI National Conference Abstract

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1102 — Trust in VA, experiences of care, and perceived quality impact preference for setting of future care among Veterans with PTSD

Lead/Presenter: Erin Finley,  COIN - Los Angeles
All Authors: Finley EP (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, UT Health San Antonio), Haro EK (UT Health San Antonio, South Texas Veterans Health Care System), Mader M (South Texas Veterans Health Care System) Noël PH (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, UT Health San Antonio) Garcia HA (Valley Coastal Bend Veterans Health Care System) Vogt D (National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston University School of Medicine) Bernardy N (National Center for PTSD, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth) Bollinger M (Central Arkansas Veterans Healthcare System) Pugh MJ (Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, VA Salt Lake City Health Care System, University of Utah Health Science Center)

Objectives:
More than a million Veterans of all combat eras are service-connected for posttraumatic stress disorder (PTSD), making PTSD care a high-priority concern for VA. Yet research on factors driving Veterans' decision-making regarding preferred setting for PTSD care has been limited. The purpose of this study was to understand factors associated with preferences for setting of future PTSD care among Veterans service-connected for PTSD.

Methods:
We conducted a cross-sectional mailed survey among Veterans with service connection for PTSD in Texas and Vermont identified from the Veterans Services Network Corporate Mini Master File (VETSNET). Survey items were intended to elucidate PTSD healthcare decision-making and queried utilization, prior experiences of care, perceived need for care, and preferences for VA, community, and/or military setting for receipt of future PTSD care. Logistic regression was used to identify factors associated with preference for future care setting.

Results:
Veterans (n = 2,327) were surveyed with an overall response rate of 37.1%. Most Veterans (72.4%) identified VA as a preferred site for their future PTSD care; a substantial, but smaller, number of Veterans identified being interested in receiving care in community (39.9%) and military (12.7%) settings. Factors associated with preferences for future care setting included demographics (e.g., ethnicity, income), availability of healthcare coverage, prior experiences of care, and attitudes related to perceived quality of care and trust in VA.

Implications:
Amid ongoing policy debate over the best way to ensure Veterans have consistent access to healthcare, few studies have examined Veterans' own preferences for healthcare utilization. These findings suggest that alignment with Veteran preferences for care setting will require retaining foundational mental health services within VA, as well as continuing to invest in provider network capacity in community settings. Veterans who have received VA care generally report high trust in VA healthcare, but trust remains a barrier for Veterans with little experience of VA care.

Impacts:
Understanding Veterans' preferences for care setting is of significant importance following passage of the VA MISSION Act in 2018. Targeted outreach to earn and sustain Veterans' trust in VA is likely to remain a critical part of engagement in VA care moving forward.