Franco Zeno E, Logan Clinton, Flower Mark, Curry Bob, Ruffalo Leslie, Brazauskas Ruta, Whittle Jeff
Prog Community Health Partnersh. 2016 Spring;10(1):31-44. doi: 10.1353/cpr.2016.0012.
Ensuring veterans' access to healthcare is a national priority. Prior studies of veterans' use of Veterans Health Administration (VA) healthcare have had limited success in evaluating barriers to access for certain vulnerable veteran subpopulations.
Our coalition of researchers and veteran community members sought to understand factors affecting use of VA, particularly for those less likely to participate in traditional survey studies.
We recruited 858 veterans to complete a collaboratively designed survey at community events or via social media. We compared our results regarding VA use with the 2010 National Survey of Veterans (NSV) using chi-square tests, multiple logistic regression to identify predictors of VA use, and content analysis for open-ended descriptions of barriers to VA use.
Veterans in our study were more likely than NSV respondents to report using VA healthcare ever (76% vs. 28%; p<0.0001). Within this group, more veterans in our sample were current VA users (83% vs. 68%; p<0.0001). In multivariable analysis, VA use was predicted by self-reported physical problems (comparing "a lot" vs. "none" for each variable, adjusted odds ratio [OR], 8.35), thinking problems (OR, 1.14), need for smoking cessation (OR, 1.54), need for pain management (OR, 1.65), and need for other mental health services (OR, 3.04). We identified 15 themes summarizing veterans' perceived barriers to VA use.
Persistent actual and perceived barriers prevent some veterans from using VA services. The VA can better understand and address these issues through community-academic partnerships with veterans' organizations.
确保退伍军人获得医疗保健是一项国家优先事项。先前关于退伍军人使用退伍军人健康管理局（VA）医疗保健的研究在评估某些弱势退伍军人亚群体获得医疗保健的障碍方面成效有限。
我们的研究人员和退伍军人社区成员联盟试图了解影响VA使用的因素，特别是对于那些不太可能参与传统调查研究的人。
我们招募了858名退伍军人，让他们在社区活动中或通过社交媒体完成一项合作设计的调查。我们使用卡方检验、多元逻辑回归来确定VA使用的预测因素，并对VA使用障碍的开放式描述进行内容分析，将我们关于VA使用的结果与2010年全国退伍军人调查（NSV）进行比较。
我们研究中的退伍军人比NSV受访者更有可能报告曾经使用过VA医疗保健（76%对28%；p<0.0001）。在这个群体中，我们样本中的更多退伍军人目前是VA的使用者（83%对68%；p<0.0001）。在多变量分析中，自我报告的身体问题（比较每个变量的“很多”与“没有”，调整后的优势比[OR]，8.35）、思维问题（OR，1.14）、戒烟需求（OR，1.54）、疼痛管理需求（OR，1.65）和其他心理健康服务需求（OR，3.04）可预测VA的使用。我们确定了15个主题，总结了退伍军人认为的VA使用障碍。
持续存在的实际和感知障碍阻碍了一些退伍军人使用VA服务。VA可以通过与退伍军人组织建立社区 - 学术伙伴关系来更好地理解和解决这些问题。
