Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael S.; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Богдан, Олена; Hastings, Jaime L.; Kapinos, Kandice A.; Kress, Amii M.; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M.; Weinick, Robin M.; Woods, Dulani; Hosek, Susan D.; Farmer, Carrie M.

doi:10.7249/rr1165.1

Cited by 68 publications

(13 citation statements)

References 73 publications

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“…This study has limitations. First, our results are focused on the US veteran population, which differs from civilian popu-lations in age distribution, comorbidity, and socioeconomic factors, 30 and may have unique environmental exposures associated with increased baseline risk of prostate cancer 31 ; as such, our results may not generalize to other populations. Second, while our denominators represent patients with an inpatient or outpatient encounter in each VHA facility each year, some veterans may have received care at several facilities each year and others may have moved between primary facilities during the study period.…”

Section: Limitationsmentioning

confidence: 99%

Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities

et al. 2022

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ImportanceThere is controversy about the benefit of prostate-specific antigen (PSA) screening. Prostate-specific antigen screening rates have decreased since 2008 in the US, and the incidence of metastatic prostate cancer has increased. However, there is no direct epidemiologic evidence of a correlation between population PSA screening rates and subsequent metastatic prostate cancer rates.ObjectiveTo assess whether facility-level variation in PSA screening rates is associated with subsequent facility-level metastatic prostate cancer incidence.Design, Setting, and ParticipantsThis retrospective cohort used data for all men aged 40 years or older with an encounter at 128 facilities in the US Veterans Health Administration (VHA) from January 1, 2005, to December 31, 2019.ExposuresYearly facility-level PSA screening rates, defined as the proportion of men aged 40 years or older with a PSA test in each year, and long-term nonscreening rates, defined as the proportion of men aged 40 years or older without a PSA test in the prior 3 years, from January 1, 2005, to December 31, 2014.Main Outcomes and MeasuresThe main outcomes were facility-level yearly counts of incident metastatic prostate cancer diagnoses and age-adjusted yearly metastatic prostate cancer incidence rates (per 100 000 men) 5 years after each PSA screening exposure year.ResultsThe cohort included 4 678 412 men in 2005 and 5 371 701 men in 2019. Prostate-specific antigen screening rates decreased from 47.2% in 2005 to 37.0% in 2019, and metastatic prostate cancer incidence increased from 5.2 per 100 000 men in 2005 to 7.9 per 100 000 men in 2019. Higher facility-level PSA screening rates were associated with lower metastatic prostate cancer incidence 5 years later (incidence rate ratio [IRR], 0.91 per 10% increase in PSA screening rate; 95% CI, 0.87-0.96; P &lt; .001). Higher long-term nonscreening rates were associated with higher metastatic prostate cancer incidence 5 years later (IRR, 1.11 per 10% increase in long-term nonscreening rate; 95% CI, 1.03-1.19; P = .01).Conclusions and RelevanceFrom 2005 to 2019, PSA screening rates decreased in the national VHA system. Facilities with higher PSA screening rates had lower subsequent rates of metastatic prostate cancer. These data may be used to inform shared decision-making about the potential benefits of PSA screening among men who wish to reduce their risk of metastatic prostate cancer.

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Section: Limitationsmentioning

confidence: 99%

Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities

et al. 2022

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“…As a Whole Health System of Care, VA also provides access to a range of complementary and integrative health (CIH) modalities. For example, yoga, tai chi, mindfulness, and acupuncture are part of the VA health benefits package, 23 and veterans in many VA facilities also have access to group or individual Whole Health Coaching [24][25][26] to help them work toward their goals.…”

Section: Introductionmentioning

confidence: 99%

“Then COVID happened…”: Veterans’ Health, Wellbeing, and Engagement in Whole Health Care During the COVID-19 Pandemic

Purcell

Sells

McGrath

et al. 2021

Glob Adv Health Med

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Background Little is known about the COVID-19 pandemic’s impact on US military veterans’ health, wellbeing, and care engagement. Healthcare systems like VA need additional information about the pandemic’s biopsychosocial impacts and how a Whole Health approach may help to address them. Objective To examine how the pandemic has affected veterans’ health, wellbeing, and engagement in the VA Whole Health System of Care. Method We conducted qualitative interviews with 40 veterans at a large multicampus VA healthcare system during the pandemic. Informed by a Whole Health approach, interviews used open-ended questions to holistically explore pandemic impacts on mental and physical health, healthcare access and engagement, social support, coping strategies, and use of VA healthcare and wellness services. Interviews were conducted by telephone, audio-recorded, and analyzed using a matrix-based technique. Interviews were supplemented by an original survey assessing pandemic impacts; descriptive frequencies were calculated to describe and characterize the interviewed sample. Interview Results Nearly, all participating veterans described significant pandemic impacts on their wellbeing, especially loneliness and sorrow stemming from isolation and disruptions to ordinary routines. These emotional impacts—sometimes combined with new constraints on care access and personal mobility—disrupted veterans’ health plans and sometimes deterred engagement in both routine and wellness care. Veterans already struggling with chronic mental and physical health conditions and those who experienced transitions or losses during the pandemic described the most severe impacts on their wellbeing. Virtual VA wellness services, especially health coaching and mind-body wellness groups, were a key source of support and connection for those who engaged in them. Conclusion We discuss the implications of our findings for care systems attempting to implement a Whole Health System of Care, including how they can address postpandemic barriers to engagement in healthcare and wellness programs, and how wellness programs can be leveraged to support those most at risk after the COVID-19 pandemic and in future crises.

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“…43 These policies helped increase access to and choice in healthcare providers among veterans, many of whom live in rural areas. 44 However, they may also lead to fragmented care and gaps in information transfer between providers, increasing veterans' risk of concurrent psychotropic medication. 30,45 Our past work examining prescription overlap among all post-9/11 VA users in Oregon suggested that, even while controlling for potentially confounding patient characteristics, veterans enrolled in the Choice Program were more likely to have overlapping VA and non-VA prescriptions than those who were not.…”

Section: Discussionmentioning

confidence: 99%

Receipt of Concurrent VA and Non-VA Opioid and Sedative-Hypnotic Prescriptions Among Post-9/11 Veterans With Traumatic Brain Injury

Ashraf

Gilbert

Holmer

et al. 2021

Journal of Head Trauma Rehabilitation

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Objective: Receipt of concurrent psychotropic prescription medications from both US Department of Veterans Affairs (VA) and non-VA healthcare providers may increase risk of adverse opioid-related outcomes among veterans with traumatic brain injury (TBI). Little is known about patterns of dual-system opioid or sedative-hypnotic prescription receipt in this population. We estimated the prevalence and patterns of, and risk factors for, VA/ non-VA prescription overlap among post-9/11 veterans with TBI receiving opioids from VA providers in Oregon. Setting: Oregon VA and non-VA outpatient care. Participants: Post-9/11 veterans in Oregon with TBI who received an opioid prescription from VA providers between the years of 2014 and 2019. Design: Historical cohort study. Main Measures: Prescription overlap of VA opioids and non-VA opioids or sedative-hypnotics; proportions of veterans who received VA or non-VA opioid, benzodiazepine, and nonbenzodiazepine sedative-hypnotic prescriptions were also examined by year and by veteran characteristics. Results: Among 1036 veterans with TBI receiving opioids from the VA, 210 (20.3%) received an overlapping opioid prescription from a non-VA provider; 5.3% received overlapping benzodiazepines; and none received overlapping nonbenzodiazepine sedative-hypnotics. Proportions of veterans with prescription overlap tended to decrease over time. Veterans with other than urban versus urban addresses (OR = 1.4; 95% CI, 1.0-1.8), high versus medium average annual VA visits (OR = 1.7; 95% CI, 1.1-2.6), and VA service connection of 50% or more versus none/0% to 40% (OR = 4.3; 95% CI, 1.3-14.0) were more likely to have concurrent VA/non-VA prescriptions in bivariable analyses; other than urban remained associated with overlap in multivariable models. Similarly, veterans with comorbid posttraumatic stress disorder diagnoses were more likely to have concurrent VA/non-VA prescriptions in both bivariable and multivariable (OR = 2.1; 95% CI, 1.0-4.1) models. Conclusion: Among post-9/11 veterans with TBI receiving VA opioids, a considerable proportion had overlapping non-VA prescription medications. Providers and healthcare systems should consider all sources of psychotropic prescriptions, and risk factors for overlapping medications, to help mitigate potentially unsafe medication use among veterans with TBI. Key words: analgesics, benzodiazepines/ * therapeutic use, brain injuries, drug overdose/epidemiology, drug prescriptions/statistics and numerical data, dual use, Iraq War, 2003-2011 safety, opioid/ * therapeutic use, traumatic, VA healthcare system, veterans/ * statistics and numerical data

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Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

Cited by 68 publications

References 73 publications

Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities

Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities

“Then COVID happened…”: Veterans’ Health, Wellbeing, and Engagement in Whole Health Care During the COVID-19 Pandemic

Receipt of Concurrent VA and Non-VA Opioid and Sedative-Hypnotic Prescriptions Among Post-9/11 Veterans With Traumatic Brain Injury

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