Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA.
J Community Health. 2013 Feb;38(1):70-7. doi: 10.1007/s10900-012-9583-7.
The purpose of this study was to develop an in-depth understanding of the barriers and enablers of effective dual care (care obtained from the Veterans Health Administration [VHA] and the private health system) for rural veterans. Telephone interviews of a random sample of 1,006 veterans residing in rural Nebraska were completed in 2010. A high proportion of the rural veterans interviewed reported receiving dual care. The common reasons cited for seeking care outside the VHA (or VA [Veterans Administration]) included having an established relationship with a non-VA provider and distance to the nearest VA medical center. Almost half of the veterans who reported having a personal doctor or nurse reported that this was a non-VA provider. Veterans reported high levels of satisfaction with the quality of care they receive. Ordinal logistic regression models found that veterans who were Medicare beneficiaries, and who rated their health status higher had higher satisfaction with dual care. The reasons cited by the veterans for seeking care at the VHA (quality of VHA care, lower costs of VHA care, entitlement) and veterans perceptions about dual care (confused about where to seek care for different ailments, perceived lack of coordination between VA and non VA providers) were significant predictors of veterans' satisfaction with dual care. This study will guide policymakers in the VA to design a shared care system that can provide seamless, timely, high quality and veteran centered care.
本研究旨在深入了解农村退伍军人有效双重护理（同时从退伍军人健康管理局 [VHA] 和私人医疗系统获得的护理）的障碍和促进因素。2010 年，对居住在内布拉斯加州农村的 1006 名退伍军人进行了随机抽样的电话访谈。接受采访的农村退伍军人中有很大一部分报告接受了双重护理。他们在 VHA（或 VA [退伍军人管理局]）之外寻求护理的常见原因包括与非 VA 提供者建立了关系以及距离最近的 VA 医疗中心。近一半报告有私人医生或护士的退伍军人表示这是非 VA 提供者。退伍军人对他们所接受的护理质量表示高度满意。有序逻辑回归模型发现，医疗保险受益人和自认为健康状况较好的退伍军人对双重护理的满意度更高。退伍军人选择在 VHA 就医的原因（VHA 护理的质量、VHA 护理的成本较低、应享权利）和退伍军人对双重护理的看法（对不同疾病应在何处寻求护理感到困惑，认为 VA 和非 VA 提供者之间缺乏协调）是退伍军人对双重护理满意度的重要预测因素。本研究将为 VA 的政策制定者提供指导，设计一种共享护理系统，为退伍军人提供无缝、及时、高质量和以退伍军人为中心的护理。
