School of Nursing, College of Health and Human Services, The University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA.
BMC Health Serv Res. 2013 Dec 1;13:498. doi: 10.1186/1472-6963-13-498.
The U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans.
We studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care.
Nearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees' odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee's odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care.
This study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to receiving services exclusively from the VA, including mutable health delivery system factors.
美国退伍军人事务部（VA）实施了创伤后综合治疗系统，以满足从阿富汗和伊拉克作战行动中返回的多名伤员的医疗需求。需要研究从患有创伤后应激障碍和其他复杂健康后果的退伍军人的角度，以及从他们在阿富汗和伊拉克服役后的角度，系统评估使用全面和独家 VA 医疗保健服务的障碍。这些观点可以为向返回的退伍军人提供最佳护理服务提供政策信息。
我们使用结构化临床访谈和定性开放式问题研究了来自两个创伤后康复中心的作战退伍军人（n=359），并辅以从电子健康记录中收集的数据。我们的结果包括几项独家使用 VA 护理的措施，我们的主要暴露是报告的护理获取障碍。
近三分之二的退伍军人报告了一个或多个使用 VA 医疗保健服务的障碍。这些障碍预测了独家使用 VA 医疗保健服务的差异。经历任何障碍都会使退伍军人不使用 VA 独家使用医疗服务的可能性增加一倍，VA 障碍的地理距离导致退伍军人不使用 VA 的可能性增加 7 倍，报告等待时间障碍使退伍军人不使用 VA 的可能性增加一倍。患有创伤后应激障碍的退伍军人与其他返回的退伍军人在获取障碍方面没有明显差异，这表明这些障碍可能是普遍的障碍，可预测使用 VA 独家进行医疗保健的差异。
这项研究初步描述了所有军种参与阿富汗或伊拉克作战行动的退伍军人返回者使用 VA 创伤后康复和其他医疗保健的情况。我们的研究结果表明，这些退伍军人报告了接受服务的重要污名化和障碍，包括可改变的医疗服务提供系统因素。
