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2023 HSR&D/QUERI National Conference Abstract

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4137 — Barriers Accessing Care among Rural Veterans with Disabilities

Lead/Presenter: Caroline Gray,  COIN - Palo Alto
All Authors: Gray CP (Center for Innovation to Implementation, Palo Alto), Egelfeld, J; Center for Innovation to Implementation, Palo Alto Vashi, A; Center for Innovation to Implementation, Palo Alto

Objectives:
Patients with disabilities report significant barriers accessing care, leading to troubling disparities in healthcare experiences and outcomes. For rural patients with disabilities, these challenges are exacerbated. Currently, there is a dearth of research focusing on the care experiences of rural Veterans with disabilities who receive VA care. To fill this gap, we conducted exploratory qualitative research that assesses their experiences accessing and receiving care at VA.

Methods:
We conducted semi-structured interviews with thirty rural-dwelling Veterans who experience one of three disabilities: hearing, vision, and mobility loss. These disabilities are highly prevalent among VA users but also diverse enough to highlight the range of ways that disability status may impact care access and experience. We used administrative data to identify participants and sought maximum variation in our sample based on geography, race/ethnicity, and gender. Patients were asked to describe experiences obtaining care at the VA in a variety of clinical contexts and through both in-person and virtual modalities. Using an abductive approach to data analysis, we catalogued reported access barriers and overall experiences.

Results:
Interview participants were mostly satisfied with their care, particularly those who had received or were receiving rehabilitation services (e.g., blind rehab centers), but they nevertheless identified barriers to accessing high-quality, satisfactory care. These barriers primarily fell into four categories: (1) communications and interactions with healthcare staff (inability to hear and/or see providers and staff, often exacerbated by universal masking requirements and social distancing during the pandemic); (2) transportation (eligibility for and availability of transportation services was a reported problem, particularly for Veterans in extremely rural locations); (3) physical layout of facilities (construction and other changes to physical space and lack of functioning elevators sometimes presented challenges); (4) digital barriers (though many Veterans appreciated virtual services and other digital technologies, they noted some accessibility challenges associated with these platforms). In addition, the lack of a consistent and uniform mechanism for identifying Veterans’ accessibility needs prior to visits proved problematic for visits at new locations and/or with new providers. The burden was generally placed on Veterans to notify staff of these accessibility needs.

Implications:
This exploratory qualitative work suggests that rural Veterans with disabilities do experience barriers accessing care. The VA has a robust and highly regarded research arm that focuses on repairing or restoring function to Veterans with disabilities. However, less attention has been paid to identifying changes to the care delivery system more generally to ensure that care is accessible and equitable for these patients. Further quantitative evaluation is needed to ascertain the degree of these barriers and to identify care settings where barriers may be more prevalent.

Impacts:
Local and national changes to care delivery would improve access to and overall satisfaction with care for Veterans with disabilities, both rural and urban.