Study Suggests Poor Communication between VA and Non-VA Primary Care Providers co-Managing Rural Veterans
BACKGROUND:
Concurrent use of VA and non-VA healthcare services is relatively high among Veterans living in rural settings, who account for 41% of the 7.8 million Veterans enrolled in VA healthcare. Estimates of Veterans' dual use of primary care services range from 28%-75%, with the highest rates found among Veterans living in rural settings and those living greater distances from VA facilities. While the PACT (Patient-Aligned Care Team) model addresses care coordination, it does not specifically address dual primary care utilization. This study examined the perspectives of community-based, non-VA primary care providers (PCPs) regarding their experiences co-managing Veterans with VA providers. Investigators conducted 21 telephone interviews and also surveyed 67 non-VA PCPs who were part of a practice-based research network in Iowa in 2011 [85% of the non-VA PCPs identified 1%-10% of their patients as Veteran dual users]. Survey questions focused on: number of Veterans seen, commun-ication with VA, perceived reasons for dual use, familiarity with VA formulary, referral practices, and perceived impact of dual use on health outcomes. Providers also were asked about potential solutions and best practices for communication exchange, as well as preferred communication methods.
FINDINGS:
- Communication with VA was viewed as poor by 66% of non-VA primary care providers, and many non-VA PCPs (42%) believed this led to poor patient outcomes. They also felt that they interacted with VA as a system rather than with individual VA providers.
- While the majority of non-VA providers were dissatisfied with their communication with VA providers, this did not translate into a negative opinion of VA healthcare; most felt the overall quality of VA care was high.
- Veterans were identified as the main medium for information transfer between VA and non-VA providers, which was viewed as undesirable.
- When non-VA PCPs were asked about their ideal method of communication, they most commonly identified electronic health records and fax that would occur automatically. They also identified the need for a VA point of contact to triage direct calls from non-VA providers.
- When asked which VA services their patients used, non-VA PCPs identified: prescription medications (91%), primary care (60%), medical specialty care (45%), preventive care (43%), mental healthcare (21%), and surgical sub-specialty care (16%).
LIMITATIONS:
- These findings reflect only the non-VA providers' experience.
- No validated survey instrument existed to explore co-management between two PCPs.
IMPLICATIONS:
- A partnership between VA and non-VA PCPs through the PACT model could improve healthcare delivery for an at-risk and growing population of Veterans residing in rural settings.
AUTHOR/FUNDING INFORMATION:
This study was supported by the Veterans Rural Health Resource Center – Central Region and HSR&D. Dr. Reisinger was supported by an HSR&D Career Development Award. Drs. Charlton, Stewart, Ono, and Reisinger, and Ms. Lampman are part of HSR&D's Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City, IA.
Gaglioti A, Cozad A, Wittrock S, Stewart K, Lampman M, Ono S, Reisinger H, and Charlton M. Non-VA Primary Care Providers Perspectives on Co-Management for Rural Veterans. Military Medicine. November 2014;179(11):1236-43.
