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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

Abstract

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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References

  1. 1.
    Vision for Change: A Plan to Restructure the Veterans Health Administration, Washington, DC: VA Undersecretary for Health; February 1995.Google Scholar
  2. 2.
    Starfield B. Primary Care: Concept, Evaluation, and Policy, New York, NY: Oxford University Press; 1992.Google Scholar
  3. 3.
    Fisher ES, Welch HG. The future of the Department of Veterans Affairs health care system. JAMA. 1995;273:651–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Fisher ES. VA Outcomes Group 1994 Report. Unmanaged Care: Dual Utilization of the Veterans Health Administration and Medicare Health Care Systems. White River Junction, Vt: Veterans Affairs Medical Center; 1994.Google Scholar
  5. 5.
    Fleming C, Fisher ES, Chang C, Bubolz TA, Malenka DJ. Studying outcomes and hospital utilization in the elderly: the advantages of a merged data base for Medicare and Veterans Affairs hospitals. Med Care. 1992;30:377–91.PubMedCrossRefGoogle Scholar
  6. 6.
    Wright SM, Daley J, Fisher ES, Thibault GE. Where do elderly veterans obtain care for acute myocardial infarction: Department of Veterans Affairs or Medicare? Health Serv Res. 1997;31:739–54.PubMedGoogle Scholar
  7. 7.
    Hisnanick J. The Impact of Medicare on the Hospital Usage Patterns of Elderly and Disabled Veterans. Washington, DC: National Center for Veterans Analysis and Statistics; July 1994. Statistical Report.Google Scholar
  8. 8.
    Passman LJ, Garcia RE, Campbell BSA, Winter E. Elderly veterans receiving care at a Veterans Affairs Medical Center while enrolled in Medicare-financed HMOs. J Gen Intern Med. 1997;12:247–9.PubMedGoogle Scholar
  9. 9.
    DeVito CA, Morgan RO, Virnig BA. Use of Veterans Affairs medical care by enrollees in Medicare HMOs. N Engl J Med. 1997;337:1013–4. Letter.PubMedCrossRefGoogle Scholar
  10. 10.
    Cowper DC, Manheim LM, Weaver FM, Pawlow AJ. Mix and match: VA and non-VA care for elderly veterans. VA Practitioner. 1993;10:41–4.Google Scholar
  11. 11.
    Yano EM, Kominski G, Rubenstein LV. Characteristics associated with obtaining care outside the VA. Presented at the 13th Annual VA HSR&D Service Meeting, Washington, DC; 1995. Abstract.Google Scholar
  12. 12.
    Horgan C, Taylor A, Wilensky G. Aging veterans: will they overwhelm the VA medical system? Health Aff (Millwood). 1983;2:77–86.CrossRefGoogle Scholar
  13. 13.
    Page WF. Why veterans choose veterans administration hospitalization: a multivariate model. Med Care. 1982:20:308–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Schlesinger M, Moran A, Zangwill L. Utilization of the VA by elder veterans: an empirical analysis. In: Wetle T, Rowe J, eds. Older Veterans: Linking VA and Community Resources. Cambridge, Mass: Harvard University Press; 1984;321–68.Google Scholar
  15. 15.
    Randall M, Kilpatrick KE, Pendergast JF, Jones KR, Vogel WB. Differences in patient characteristics between Veterans Administration and community hospitals: implications for VA planning. Med Care. 1987;25:1099–104.PubMedCrossRefGoogle Scholar
  16. 16.
    Kosloski K, Austin C, Borgatta E. Determinants of VA utilization: the 1983 survey of veterans. Med Care. 1987;25:830–46.PubMedGoogle Scholar
  17. 17.
    Wolinsky FD, Coe RM, Mosely RR II, Homan SM. Veterans’ and non-veterans’ use of health services: a comparative analysis. Med Care. 1985;23:1358–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Ware JE Jr, Snyder MK, Wright WR, Davies AR. Defining and measuring patient satisfaction with medical care. Eval Prog Plan. 1983;6:247–63.CrossRefGoogle Scholar
  19. 19.
    Davies AR, Ware JE. Involving consumers in quality of care assessment. Health Aff (Millwood). 1988;7:33–48.CrossRefGoogle Scholar
  20. 20.
    Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality of care. Inquiry. 1988;25:25–36.PubMedGoogle Scholar
  21. 21.
    Ware JE Jr, Davies AR. Behavioral consequences of consumer dissatisfaction with medical care. Eval Prog Plan. 1983;6:291–7.CrossRefGoogle Scholar
  22. 22.
    Marquis MS, Davies AR, Ware JE Jr. Patient satisfaction and change in medical care provider: a longitudinal study. Med Care. 1983;21:821–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Lederle FA, Parenti CM. Prescription drug costs as a reason for changing physicians. J Gen Intern Med. 1994;9:162–3.PubMedCrossRefGoogle Scholar

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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