Journal of General Internal Medicine

, Volume 14, Issue 5, pp 274–280 | Cite as

Dual use of VA and non-VA primary care

  • Steven J. Borowsky
  • Diane C. Cowper
Original Articles


OBJECTIVE: To determine how frequently veterans use non-Department of Veterans Affairs (VA) sources of care in addition to primary care provided by the VA and to assess the association of this pattern of “dual use” to patient characteristics and satisfaction with VA care.

DESIGN: Cross-sectional telephone survey of randomly selected patients from four VA medical centers.

PARTICIPANTS: Of 1,240 eligible veterans, 830 (67%) participated in the survey.

MEASUREMENTS AND MAIN RESULTS: Survey data were used to assess whether a veteran reported receiving primary care from both VA and non-VA sources of care, as well as the proportion of all primary care visits made to non-VA providers. Of 577 veterans who reported VA primary care visits, 159 (28%) also reported non-VA primary care visits. Among these dual users the mean proportion of non-VA primary care visits was 0.50. Multivariate analysis revealed that the odds of dual use were reduced for those without insurance (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.18, 0.66) and with less education (OR 0.60; 95% CI 0.38, 0.92), while increased for those not satisfied with VA care (OR 2.40; 95% CI 1.40, 4.13). Among primary care dual users, the proportion of primary care visits made to non-VA providers was decreased for patients with heart disease (p<.05) and patients with alcohol or drug dependence (p<.05).

CONCLUSIONS: Primary care dual use was common among these veterans. Those with more education, those with any type of insurance, and those not satisfied with VA care were more likely to be dual users. Non-VA care accounted for approximately half of dual users’ total primary care visits.

Key words

veterans primary care patient satisfaction health services research utilization 


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Copyright information

© Society of General Internal Medicine 1999

Authors and Affiliations

  • Steven J. Borowsky
    • 1
  • Diane C. Cowper
    • 2
  1. 1.the VAMC Center for Chronic Disease Outcomes ResearchMinneapolis
  2. 2.the Midwest Center for Health Services and Policy Research, HSR&D Field ProgramEdward Hines Jr. Veterans Affairs HospitalHines

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