4076 — Patterns of Veterans Health Administration Health Care Use Among Gulf War Veterans
Lead/Presenter: Sarah Ahmed,
COIN - Houston
All Authors: Ahmed ST (VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, MEDVAMC, Houston, TX; Section of HSR, Dept. of Medicine, BCM, Houston TX), Richardson P (VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, MEDVAMC, Houston, TX; Section of Health Services Research, Dept. of Medicine, Baylor College of Medicine, Houston TX); Li R(Dept. of Biostatistics and Data Science, University of Texas School of Public Health, Houston, TX) Steele L (Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX) Morgan R (Dept. of Management, Policy & Community Health, University of Texas School of Public Health, Houston, TX) Delclos G (Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX) Helmer DA (VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; Section of Health Services Research, Dept. of Medicine, Baylor College of Medicine, Houston TX)
Many Gulf War veterans (GWVs) report persistent unexplained symptoms and may have higher rates of certain conditions, e.g., cardiovascular disease and risk factors. Yet their use of Veterans Health Administration (VHA) healthcare services is not well understood. We investigate the healthcare utilization patterns in the VHA of deployed GWVs with and without Gulf War Illness (GWI).
This is a retrospective analysis of survey and VHA electronic health record (EHR) data for participants from the Gulf War Era Cohort and Biorepository (Cooperative Studies Program 585 (CSP585)) who deployed to the 1990-1991 Persian Gulf War. The sample included VHA users, those who accessed VHA services in the five years prior to survey completion according to VHA EHR data in the VA National Corporate Data Warehouse. CSP585 surveys were completed between 2014-2016. Survey data included age at survey completion, sex, race/ethnicity, branch of service and symptoms. We defined GWI according to the Centers for Disease Control and Prevention (CDC)-severe multisymptom illness criteria using self-reported symptoms. Inpatient and outpatient visits to primary care, specialty care [cardiology/endocrinology], mental health care, ambulatory care and hospitalizations were extracted using International Classification of Disease (ICD) 9/10 and clinic stop codes. We compared healthcare use in the five years prior to survey completion by GWI status in two steps: 1) any use of the specified services using separate multivariable logistic regression models; and 2) volume of specified service use (number of visits) using multivariable zero-truncated negative binomial models.
From a total of 1343 CSP585 participants, 942 (70%) were deployed to the GW theater and 698(74%) of these used VHA services in the five years preceding survey completion; the final analytical sample with complete data was 656 (70%). Most VHA users 493 (75%) accessed primary care, 114 (17%) accessed specialty care, 283 (43%) mental health care, 223 (34%) emergency care and 73 (11%) were hospitalized. GWVs meeting the CDC-severe criteria (compared to those who did not) had 2.5 higher odds (95% CI 1.58-3.94) of accessing VHA primary care services. They were also more likely to use emergency care (OR 2.15; 95% CI 1.50-3.09), specialty care (OR 2.79; 95% CI 1.78-4.36), mental health care (OR 3.81; 95% CI 2.64-5.49) and be admitted to the hospital (OR 1.72; 95% CI 1.00-2.94). When examining volume of use in the five-year period, GWVs meeting the CDC severe criteria had a significantly higher rate of primary care visits (IRR 1.49; 95% CI 1.26-1.77) but the differences in volume for the other examined healthcare services were not statistically significant.
GWVs with severe GWI have higher odds of any use of a variety of VHA services compared to GWVs without GWI. However, among those who used each type of VHA care, only the volume of primary care use was higher among those with GWI.
Our research suggests that GWVs with GWI may access diverse VHA healthcare services more than GWVs without GWI, but the use may not persist over time except for primary care. This raises concerns about patient-perceived access and experience.