Charlene A Pope1,2, Boyd H Davis1,3, Leticia Wine1, Lynne S Nemeth4, K Sue Haddock5, Tom Hartney6, R Neal Axon1,7. 1. 1 Health Equity & Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs (VA) Medical Center, Charleston, SC, USA. 2. 2 Division General Pediatrics, Department of Pediatrics, College of Medicine, Medical University of South Carolina (MUSC), Charleston, USA. 3. 3 University of North Carolina-Charlotte, Charlotte, NC, USA. 4. 4 College of Nursing, Medical University of South Carolina, Charleston, SC, USA. 5. 5 William J.B. Dorn VA Medical Center, Columbia, SC, USA. 6. 6 Charlie Norwood VA Medical Center, Augusta, GA, USA. 7. 7 Department of Internal Medicine, College of Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA.
Abstract
OBJECTIVES: This study explores perceptions of US Veterans Affairs (VA) and non-VA healthcare providers caring for Veterans with heart failure (HF) regarding Veteran knowledge and motivations for dual use, provider roles in recommending and coordinating dual use, systems barriers and facilitators, and suggestions for improving cross-system care. METHODS: Twenty VA and 11 non-VA providers participated in semi-structured interviews, which were analyzed using parallel qualitative content and discourse analysis. RESULTS: VA and non-VA providers described variable HF knowledge and self-management among Veterans, and both groups described the need for improved education addressing medication adherence, self-care, and management of acute symptoms. Both groups described highly limited roles for providers in shaping choices surrounding dual use. VA and non-VA providers had significantly different perceptions regarding the availability, quality, and effectiveness of VA HF services. Multiple non-VA providers expressed frustration with and difficulty in contacting VA providers, accessing records, and making referrals into the VA system. Suggestions for improved care focused on patient education and care coordination. DISCUSSION: Dual healthcare system use for Veterans is increasingly common. Similarities and contrasts in perceptions of VA and non-VA providers are instructive and should be incorporated into future policy and program initiatives.
OBJECTIVES: This study explores perceptions of US Veterans Affairs (VA) and non-VA healthcare providers caring for Veterans with heart failure (HF) regarding Veteran knowledge and motivations for dual use, provider roles in recommending and coordinating dual use, systems barriers and facilitators, and suggestions for improving cross-system care. METHODS: Twenty VA and 11 non-VA providers participated in semi-structured interviews, which were analyzed using parallel qualitative content and discourse analysis. RESULTS: VA and non-VA providers described variable HF knowledge and self-management among Veterans, and both groups described the need for improved education addressing medication adherence, self-care, and management of acute symptoms. Both groups described highly limited roles for providers in shaping choices surrounding dual use. VA and non-VA providers had significantly different perceptions regarding the availability, quality, and effectiveness of VA HF services. Multiple non-VA providers expressed frustration with and difficulty in contacting VA providers, accessing records, and making referrals into the VA system. Suggestions for improved care focused on patient education and care coordination. DISCUSSION: Dual healthcare system use for Veterans is increasingly common. Similarities and contrasts in perceptions of VA and non-VA providers are instructive and should be incorporated into future policy and program initiatives.
Entities:
Keywords:
Veterans; decision making; dual use; heart failure; qualitative research
Authors: Kristin M Mattocks; Kristin Cunningham; A Rani Elwy; Erin P Finley; Clinton Greenstone; Michelle A Mengeling; Steven D Pizer; Megan E Vanneman; Michael Weiner; Lori A Bastian Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Seppo T Rinne; Kirsten Resnick; Renda Soylemez Wiener; Steven R Simon; A Rani Elwy Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128