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RRP 07-344 – HSR&D Study

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RRP 07-344
Access to Specialty Care Veterans with MS: Assessment and Intervention
Jodie K. Haselkorn MD MPH
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: October 2008 - December 2009

BACKGROUND/RATIONALE:
Multiple Sclerosis (MS) is a demyelinating and axonal disease of the brain and spinal cord that usually has its onset in young adulthood and often progresses over a nearly normal life span. Given the uncertain but progressive feature of MS, health care providers and administrators recommend an annual visit to a MS specialty care provider (neurology or physical medicine and rehabilitation).

OBJECTIVE(S):
This research examines potential barriers to the implementation of this recommendation in the Veterans Health Administration and reports the results of a brief pilot intervention to improve attendance. Main Outcome Measures: Study 1: Specialty care visit, receipt of medical services. Study 2: Attendance at a specialty care appointment within three months following an invitation and educational letter.

METHODS:
Study 1: Observational cohort study. Study 2: Randomized controlled trial. Setting: Veterans Health Administration (VHA).

Participants in Study 1 were drawn from the Veterans Affairs MS National Data Repository and included Veterans if they had an outpatient visit in 2007 and alive in 2008 (N=14,723).

Participants in Study 2 included Veterans with MS from the Northwest region of U.S. who did not receive a specialty care visit. They were randomly assigned to receive an invitation letter to schedule a specialty care appointment (N = 101) or to usual care (N=73).

FINDINGS/RESULTS:
Study 1: 65.5 percent (n=9,643) had a specialty care visit in 2007. Veterans who were service-connected, had greater medical comorbidity and lived in urban settings were more likely to have received a specialty care visit. Veterans who were older and had to travel greater distances to a center were less likely to have a specialty care visit.

Study 2: Attendance at a specialty care visit was significantly higher in the intervention condition (11.1%) compared to the control condition (2.7%). Access to care in rural areas and areas at greater distance from a major medical center represents a notable barrier. A brief provider-initiated contact letter facilitated engagement in care, but primarily among those who were not limited by other obstacles.

IMPACT:
This preliminary work will assist in the development of models of service delivery designed to improve access to MS care and improve adherence to current standards of care within VHA.


PUBLICATIONS:
None at this time.


DRA: Other Conditions
DRE: Treatment - Observational
Keywords: Access, Chronic disease (other & unspecified)
MeSH Terms: none

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