Research on Rural Veterans: An Analysis of the Literature

Weeks, William B.; Wallace, Amy E.; West, Alan N.; Heady, Hilda R.; Hawthorne, Kara

doi:10.1111/j.1748-0361.2008.00179.x

Cited by 70 publications

(64 citation statements)

References 65 publications

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“…For example, one potential explanation for the relatively low rates of screening among disadvantaged White veterans is that these individuals are more likely to live in rural areas than their Black counterparts and therefore may have more difficulty accessing VA care. 70,71 Also, the dominant modes of CRC screening differ within and outside the VA. FOBT is the dominant mode of screening within the VA whereas screening by colonoscopy is more common outside the VA. We conducted additional analyses and found that, among those who were adherent to CRCS, Black veterans had significantly higher rates of FOBT (60% vs. 53%, p=0.025) and lower rates of colonoscopy compared with White veterans (47% vs. 57%, p = 0.012). It may be the case that higher SES Black veterans, who are more likely than their lower SES Black counterparts to receive care outside the VA, are less likely to be offered a colonoscopy than whites receiving care outside the VA. Alternatively, higher SES blacks may be less likely than their white counterparts to find the option of colonoscopy acceptable (perhaps because it is an invasive procedure or because they are more likely to be unmarried and hence lack the necessary support required for the procedure).…”

Section: Discussionmentioning

confidence: 99%

“…If it is the case that living in a rural setting accounts for low rates of CRCS among disadvantaged White veterans, it will be critical to develop strategies to improve screening in this population. 70,71 Additional research is also needed to understand why Black veterans are less likely to be screened by colonoscopy than their White counterparts.…”

Section: Discussionmentioning

confidence: 99%

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Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

et al. 2010

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OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines. RESULTS: In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p<0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks. CONCLUSION: We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men. These disparities are partially attributable to lower rates of CRC screening (CRCS) by Blacks, 3-5 which has been shown to significantly reduce CRC mortality. [6][7][8][9] To understand what factors contribute to CRCS adherence, researchers have drawn on health behavior theories and have examined such factors as cognitions about screening, social and medical environmental factors, and demographic and health-related factors. [10][11][12] Few studies, however, have explored the extent to which racial disparities in adherence to CRCS are a function of these underlying factors, leaving unanswered questions about the best approaches to promote screening among populations with greater disease burden. [13][14][15][16][17][18][19][20] This study contributes to the broader literature on race differences in CRCS by examining the relative contribution of demographic and health factors, cognitive factors, and environmental factors to racial disparities in CRCS in a nationally representative survey of Veterans Health Affairs (VHA) patients aged 50-75.The VHA is a particularly interesting system within which to examine racial disparities in CRCS because it provides equal access to care to all qualifying veterans, and mandates that all patients be assigned to a primary care provider, both of which diminish barriers to screening that might disproportionally affect r...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

et al. 2010

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“…Our data showed that 20% of veterans live more than 50 miles from the nearest VA medical [31,32,35]. Moreover, other studies have documented poorer care among rural veterans for acute myocardial infarction, another emergent condition [1,2,26].…”

Section: Discussionmentioning

confidence: 73%

Fee-based Care is Important for Access to Prompt Treatment of Hip Fractures Among Veterans

Richardson

Cram

Vaughan-Sarrazin

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Hip fracture is a medical emergency for which delayed treatment increases risk of disability and death. In emergencies, veterans without access to a Veterans Administration (VA) hospital may be admitted to non-VA hospitals under fee-based (NVA-FB) care paid by the VA. The affect of NVA-FB care for treatment and outcomes of hip fractures is unknown. Questions/Purposes This research seeks to answer three questions: (1) What patient characteristics determine use of VA versus NVA-FB hospitals for hip fracture? (2) Does time between admission and surgery differ by hospital (VA versus NVA-FB)? (3) Does mortality differ by hospital? Methods Veterans admitted for hip fractures to VA (n = 9308) and NVA-FB (n = 1881) hospitals from 2003 to 2008 were identified. Primary outcomes were time to surgery and death. Logistic regression identified patient characteristics associated with NVA-FB hospital admissions; differences in time to surgery and death were evaluated using Cox proportional hazards regression, controlling for patient covariates. Results Patients admitted to NVA-FB hospitals were more likely to be younger, have service-connected disabilities, and live more than 50 miles from a VA hospital. Median days to surgery were less for NVA-FB admissions compared with VA admissions (1 versus 3 days, respectively). NVA-FB admissions were associated with 21% lower relative risk of death within 1 year compared with VA hospital admissions. Conclusions For veterans with hip fractures, NVA-FB hospital admission was associated with shorter time to surgery and lower 1-year mortality. These findings suggest fee-based care, especially for veterans living greater

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“…Mean length of stay among female Veterans was significantly longer for VA hospitals than private-sector hospitals even after adjustment for patient differences (Mooney & Weeks, 2007). Weeks et al (2008a) identified Veteran stays in VA and non-VA hospitals and found longer length of stay for VA hospitalization even after adjusting for patient characteristics. Berke et al (2009) found that Veterans admitted to VA hospitals had longer length of stay than expected after adjustment, compared with Veterans in non-VA hospitals.…”

Section: Efficiency Of Care In Va Compared With Non-vamentioning

confidence: 99%

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Hussey¹,

Ringel²,

Ahluwalia³

et al. 2015

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Research on Rural Veterans: An Analysis of the Literature

Abstract: The literature on rural veterans' health care needs warrants expansion and investment so that policy makers can make informed decisions in an environment of limited resources and competing interests.

Cited by 70 publications

References 65 publications

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

Fee-based Care is Important for Access to Prompt Treatment of Hip Fractures Among Veterans

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

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