Journal of General Internal Medicine

, Volume 34, Issue 4, pp 598–603 | Cite as

A Qualitative Study of Primary Care Providers’ Experiences with the Veterans Choice Program

  • Andrea L. NevedalEmail author
  • Todd H. Wagner
  • Laura S. Ellerbe
  • Steven M. Asch
  • Christopher J. Koenig
Original Research



The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with referrals are not well understood.


To understand VA PCPs’ experiences referring patients to community specialists while VA works to expand and refine the implementation of the Choice Program.


Qualitative study using interview methods.


Semi-structured telephone interviews were conducted with VA primary care providers (N = 72 out of 599 contacted) recruited nationally.


Open-ended interview questions elicited PCP perceptions and experiences with referrals to community specialists via the Choice Program. Keywords were identified using automated coding features in ATLAS.ti and evaluated using conventional content analysis to inductively describe the qualitative data.

Key Results

VA PCPs emphasized problems with care coordination and continuity between the VA and community specialists (e.g., “It is extremely difficult for us to obtain and continue continuity of care because there’s not much communication with the community specialist”). They described difficulties with tracking the initial referral, coordinating care after receiving community specialty care, accessing community medical records, and aligning community specialists’ prescriptions with the VA formulary.


The VA Choice Program provides access to community specialists for VA patients; however, VA primary care providers face challenges tracking referrals to community specialists and in coordinating care. Strategies to improve care coordination between the VA and community providers should focus on providing PCPs with information to follow Veterans throughout the Choice referral process and follow-up.


implementation research primary care specialty care referrals qualitative research Veterans 


Author Contributions

We are especially grateful to the VA primary care providers who participated in this study and shared their frontline experiences with us. We also acknowledge Elizabeth Gehlert, Paul Heidenreich, Howard Jiang, Fasiha Kanwal, Amanda Midboe, Mary Jo Pugh, Pon Su, and Jian Ying for their important contributions to the larger study.

Funding Information

This work was supported by Investigator Initiated Research (IIR) no. 12-337 from the United States Department of Veterans Affairs Health Services Research and Development Program.

Compliance with Ethical Standards


Views expressed herein are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4810_MOESM1_ESM.docx (32 kb)
ESM 1 (DOCX 32.1 kb)


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Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Andrea L. Nevedal
    • 1
    Email author
  • Todd H. Wagner
    • 1
    • 2
    • 3
  • Laura S. Ellerbe
    • 1
  • Steven M. Asch
    • 1
    • 4
  • Christopher J. Koenig
    • 1
    • 5
  1. 1.Center for Innovation to Implementation (Ci2i)VA Palo Alto Health Care SystemMenlo ParkUSA
  2. 2.Health Economics Resource Center (HERC)VA Palo Alto Health Care SystemMenlo ParkUSA
  3. 3.Department of SurgeryStanford UniversityStanfordUSA
  4. 4.Division of Primary Care and Population HealthStanford UniversityStanfordUSA
  5. 5.Department of Communication StudiesSan Francisco State UniversitySan FranciscoUSA

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