Abstract
The purpose of this study was to develop an in-depth understanding of the barriers and enablers of effective dual care (care obtained from the Veterans Health Administration [VHA] and the private health system) for rural veterans. Telephone interviews of a random sample of 1,006 veterans residing in rural Nebraska were completed in 2010. A high proportion of the rural veterans interviewed reported receiving dual care. The common reasons cited for seeking care outside the VHA (or VA [Veterans Administration]) included having an established relationship with a non-VA provider and distance to the nearest VA medical center. Almost half of the veterans who reported having a personal doctor or nurse reported that this was a non-VA provider. Veterans reported high levels of satisfaction with the quality of care they receive. Ordinal logistic regression models found that veterans who were Medicare beneficiaries, and who rated their health status higher had higher satisfaction with dual care. The reasons cited by the veterans for seeking care at the VHA (quality of VHA care, lower costs of VHA care, entitlement) and veterans perceptions about dual care (confused about where to seek care for different ailments, perceived lack of coordination between VA and non VA providers) were significant predictors of veterans’ satisfaction with dual care. This study will guide policymakers in the VA to design a shared care system that can provide seamless, timely, high quality and veteran centered care.
Similar content being viewed by others
References
Kizer, K., & Dudley, R. (2009). Extreme makeover: Transformation of the veterans health care system. Annual Review of Public Health, 303, 13–339.
National Center for Veterans Analysis and Statistics (2011). VA stats at a glance. Retrieved from http://www.va.gov/vetdata/index.asp. Accessed on November 9 2011.
Weeks, W., Kazis, L., Shen, Y., Cong, Z., Ren, X., Miller, D., et al. (2004). Differences in health-related quality of life in rural and urban veterans. American Journal of Public Health, 94(10), 1762–1767.
Kizer, K., Demakis, J., & Feussner, J. (2000). Reinventing VA health care: Systematizing quality improvement and quality innovation. Medical Care, 38(6 Suppl 1), I7–I16.
Perlin, J., Kolodner, R., & Roswell, R. (2004). The Veterans health administration: Quality, value, accountability, and information as transforming strategies for patient-centered care. The American Journal of Managed Care, 10(11 Pt 2), 828–836.
National Rural Health Association (2004). Rural veterans: A special concern for rural health advocates. Policy Brief. Retrieved from http://www.ruralhealthweb.org/go/rural-health-topics/veterans-health. Accessed on October 11, 2010.
American factfinder (2010). Veteran Status- 2010 American community survey 1 year estimates. Available at: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_1YR_S2101&prodType=table. Accessed February 13, 2012.
Weeks, W., Wallace, A., Wang, S., Lee, A., & Kazis, L. (2006). Rural-urban disparities in health-related quality of life within disease categories of veterans. The Journal of Rural Health, 22(3), 204–211.
Wallace, A., Weeks, W., Wang, S., Lee, A., & Kazis, L. (2006). Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders. Psychiatric Services (Washington DC), 57(6), 851–856.
Wallace, A., Lee, R., Mackenzie, T., West, A., Wright, S., Booth, B., et al. (2010). A longitudinal analysis of rural and urban veterans’ health-related quality of life. The Journal of Rural Health, 26(2), 156–163.
Weeks, W., Wallace, A., West, A., Heady, H., & Hawthorne, K. (2008). Research on rural veterans: an analysis of the literature. The Journal of Rural Health, 24(4), 337–344.
Chapko, M., Borowsky, S., Fortney, J., Hedeen, A., Hoegle, M., Maciejewski, M., et al. (2002). Evaluation of the Department of Veterans Affairs community-based outpatient clinics. Medical Care, 40(7), 555–560.
Schooley, B., Horan, T., Lee, P., & West, P. (2010). Rural veteran access to healthcare services: investigating the role of information and communication technologies in overcoming spatial barriers. Perspectives In Health Information Management/AHIMA, American Health Information Management Association, 71, 1–20.
Kramer, B., Wang, M., Jouldjian, S., Lee, M., Finke, B., & Saliba, D. (2009). Veterans Health Administration and Indian Health Service: Healthcare utilization by Indian Health Service enrollees. Medical Care, 47(6), 670–676.
Liu, C., Bolkan, C., Chan, D., Yano, E., Rubenstein, L., & Chaney, E. (2009). Dual use of VA and non-VA services among primary care patients with depression. J Gen Intern Med, 24(3), 305–311.
Hoff, R., & Rosenheck, R. (1998). Female veterans’ use of Department of Veterans Affairs health care services. Medical Care, 36(7), 1114–1119.
Petersen, L., Byrne, M., Daw, C., Hasche, J., Reis, B., & Pietz, K. (2010). Relationship between clinical conditions and use of veterans affairs health care among Medicare-enrolled veterans. Health Services Research, 45(3), 762–791.
Kramer, B., Vivrette, R., Satter, D., Jouldjian, S., & McDonald, L. (2009). Dual use of veterans health administration and Indian Health Service: Healthcare provider and patient perspectives. J Gen Intern Med, 24(6), 758–764.
Consumer Assessment of Healthcare Providers and Systems. CAHPS Health Plan Survey 4.0. Rockville MD: Agency for Healthcare Research and Quality. Updated 2008. Available at https://www.cahps.ahrq.gov/Surveys-Guidance/HP/Get-Surveys-and-Instructions.aspx. Accessed on March 11 2010.
Adams (2009). Closing the health gap of rural veterans: Discussion of funding and resource coordination. Written Testimony to the Health Sub Committee of the House Committee on Veterans’ Affairs.
Acknowledgments
The funding for this project was provided by the Department of Veterans Affairs, VA Nebraska—Western Iowa HCS, Omaha Division, Contract No. VA 263-BO-0102. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The views expressed are solely those of the authors and do not necessarily represent those of the Department of Veterans Affairs.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nayar, P., Apenteng, B., Yu, F. et al. Rural Veterans’ Perspectives of Dual Care. J Community Health 38, 70–77 (2013). https://doi.org/10.1007/s10900-012-9583-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-012-9583-7