Experiences with the Veterans’ Choice Program

Stroupe, Kevin T.; Martínez, Rachael N.; Hogan, Timothy P.; Gordon, Elisa J.; González, Beverly; Kale, Ibuola; Osteen, Chad; Tarlov, Elizabeth; Weaver, Frances M.; Hynes, Denise M.; Smith, Bridget

doi:10.1007/s11606-019-05224-y

Cited by 29 publications

(28 citation statements)

References 13 publications

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“…In 2014, the US Congress authorized the Veterans Choice Program (VCP), which allowed veterans to access care in the community if they lived more than 40 miles from the closest Veterans Health Administration (VHA) medical facility, could not schedule an appointment within 30 days or by the date clinically necessary (whichever was sooner), or experienced other specific hardships. 1 , 2 Since the VCP’s rollout in the fall of 2014, approximately 2 million veterans have used the program. 3 In this study, our objectives were to determine whether VHA wait times declined after VCP implementation, compare appointment wait times for specialty care in VHA vs community medical centers, and identify the proportions of community care wait times that were attributable to VHA administrative processes.…”

Section: Introductionmentioning

confidence: 99%

Appointment Wait Times for Specialty Care in Veterans Health Administration Facilities vs Community Medical Centers

2020

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Section: Introductionmentioning

confidence: 99%

Appointment Wait Times for Specialty Care in Veterans Health Administration Facilities vs Community Medical Centers

2020

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“…This result may reflect the positive relationship that Veterans have with their VAF primary care providers; prior research has shown better patient experience among Veterans receiving primary care at VA compared with in the community for communication, coordination and provider ratings. 12 , 13 It is possible that Veterans value the ability to use technologies such as secure messaging and telehealth modalities to communicate and interact with their VAF providers between visits. Our findings are also in line with prior research during the first year of VCP, which found that Veterans who used some VA community outpatient care were still very likely to stick with their VA primary care provider.…”

Section: Discussionmentioning

confidence: 99%

Veterans’ Use of Veterans Health Administration Primary Care in an Era of Expanding Choice

et al. 2021

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Background: The Veterans Choice Program (VCP), aimed at improving access to care, included expanded options for Veterans to receive primary care through community providers. Objectives: The objective of this study was to characterize and compare Veterans use of Veterans Health Administration (VA) primary care services at VA facilities and through a VA community care network (VA-CCN) provider. Research Design: This was a retrospective, observational over fiscal years (FY) 2015–2018. Subjects: Veterans receiving primary care services paid for by the VA. Measures: Veteran demographic, socioeconomic and clinical factors and use of VA primary care services under the VCP each year. Results: There were 6.3 million Veterans with >54 million VA primary care visits, predominantly (98.5% of visits) at VA facility. The proportion of VA-CCN visits increased in absolute terms from 0.7% in 2015 to 2.6% in 2018. Among Veterans with any VA-CCN primary care, the proportion of VA-CCN visits increased from 22.6% to 55.3%. Logistic regression indicated that Veterans who were female, lived in rural areas, had a driving distance >40 miles, had health insurance or had a psychiatric/depression condition were more likely to receive VA-CCN primary care. Veterans who were older, identified as Black race, required to pay VA copayments, or had a higher Nosos score, were less likely to receive VA-CCN primary care. Conclusion: As the VA transitions from the VCP to MISSION and VA facilities gain experience under the new contracts, attention to factors that impact Veterans’ use of primary care services in different settings are important to monitor to identify access barriers and to ensure Veterans’ health care needs are met.

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“… 26–29 This knowledge is also important for both VA and non-VA providers, since recent policy changes in the US have expanded access to health care for veterans outside of the VA healthcare system. 30 , 31 This service trend is also observed among service members worldwide. 24 , 32 …”

Section: Introductionmentioning

confidence: 54%

Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine

Boscarino¹,

Adams²,

Urosevich³

et al. 2022

PGPM

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Introduction Since veteran suicide is a concern and our knowledge of predictive factors is still limited, our objective was to assess risk factors for suicide, including genetic factors, among deployed veterans. Methods For this study, we surveyed 1730 veterans who were outpatients in a multi-hospital system in Pennsylvania. Altogether, 1041 veterans (60%) provided a DNA sample. The genetic risk variants investigated were within loci previously associated with PTSD and substance misuse, including CRHR1 , CHRNA5 , RORA , and FKBP5 genetic variations, which were used to calculate a polygenic risk score (range=0–8, mean=3.6, SD=1.4). Results Most veterans (56.2%) were deployed to Vietnam while significant numbers were deployed to Iraq, Afghanistan, and other post-Vietnam conflicts. Overall, 95.1% of the veterans were male, their mean age was 56.2 (SD=12), and 95.6% were Caucasian. Among the veterans, 24% had high combat exposure. The prevalence of lifetime suicidal thoughts was 11.3%. Additionally, 5.7% ever developed a suicide plan or attempted suicide in their lifetimes. Among those with a history of a lifetime suicide attempt or suicide plan, the PTSD genetic risk score was significantly higher (OR=3.96 vs 3.55, p=0.033), but for suicidal thoughts, this association was not significant (p=0.717). In multivariable analysis (MVA) logistic regression, significant predictors of attempting suicide or having a suicide plan were history of depression (OR=5.04, p<0.001), PTSD genetic risk score (OR=1.25, p=0.036), history of childhood abuse/neglect (OR=2.24, p=0.009), and lifetime marijuana use (OR= 1.56, p=0.020). Conversely, rural residence was protective for suicide risk (OR=0.49; p=0.031). For suicidal thoughts, in the MVA genetic risk score was not significant (p=0.697), but history of child abuse/neglect (p<0.001), history of depression (p>0.001), low psychological resilience (p=0.004), and lifetime marijuana use (p=0.022) were significant. Discussion In this study, we identified genetic risk variants and other predictors for suicide among veterans that may have implications for future screening and clinical care. Further research is advised.

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Experiences with the Veterans’ Choice Program

Cited by 29 publications

References 13 publications

Appointment Wait Times for Specialty Care in Veterans Health Administration Facilities vs Community Medical Centers

Appointment Wait Times for Specialty Care in Veterans Health Administration Facilities vs Community Medical Centers

Veterans’ Use of Veterans Health Administration Primary Care in an Era of Expanding Choice

Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine

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