Tsai Jack, Yakovchenko Vera, Jones Natalie, Skolnik Avy, Noska Amanda, Gifford Allen L, McInnes D Keith
*Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven †Department of Psychiatry, Yale University School of Medicine, New Haven, CT ‡Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA, Bedford, MA §Division of Infectious Diseases, Providence VA Medical Center, Providence, RI ∥Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA.
Med Care. 2017 Jul;55 Suppl 7 Suppl 1:S13-S19. doi: 10.1097/MLR.0000000000000706.
The Department of Veterans Affairs (VA) is the country's largest provider for chronic hepatitis C virus (HCV) infection. The VA created the Choice Program, which allows eligible veterans to seek care from community providers, who are reimbursed by the VA.
This study aimed to examine perspectives and experiences with the VA Choice Program among veteran patients and their HCV providers.
Qualitative study based on semistructured interviews with veteran patients and VA providers. Interview transcripts were analyzed using rapid assessment procedures based in grounded theory.
A total of 38 veterans and 10 VA providers involved in HCV treatment across 3 VA medical centers were interviewed.
Veterans and providers were asked open-ended questions about their experiences with HCV treatment in the VA and through the Choice Program, including barriers and facilitators to treatment access and completion.
Four themes were identified: (1) there were difficulties in enrollment, ongoing support, and billing with third-party administrators; (2) veterans experienced a lack of choice in location of treatment; (3) fragmented care led to coordination challenges between VA and community providers; and (4) VA providers expressed reservations about sending veterans to community providers.
The Choice Program has the potential to increase veteran access to HCV treatment, but veterans and VA providers have described substantial problems in the initial years of the program. Enhancing care coordination, incorporating shared decision-making, and establishing a wide network of community providers may be important areas for further development in designing community-based specialist services for needy veterans.
退伍军人事务部（VA）是美国慢性丙型肝炎病毒（HCV）感染的最大医疗服务提供者。退伍军人事务部设立了“选择计划”，该计划允许符合条件的退伍军人到社区医疗服务提供者处接受治疗，费用由退伍军人事务部报销。
本研究旨在探讨退伍军人患者及其HCV治疗服务提供者对退伍军人事务部“选择计划”的看法和体验。
基于对退伍军人患者和退伍军人事务部医疗服务提供者进行半结构化访谈的定性研究。访谈记录采用基于扎根理论的快速评估程序进行分析。
对来自3个退伍军人事务部医疗中心参与HCV治疗的38名退伍军人和10名退伍军人事务部医疗服务提供者进行了访谈。
向退伍军人和医疗服务提供者询问了有关他们在退伍军人事务部接受HCV治疗以及通过“选择计划”接受治疗的开放式问题，包括治疗获取和完成过程中的障碍及促进因素。
确定了四个主题：（1）在注册、持续支持以及与第三方管理机构结算费用方面存在困难；（2）退伍军人在治疗地点选择上缺乏选择；（3）医疗服务分散导致退伍军人事务部与社区医疗服务提供者之间的协调存在挑战；（4）退伍军人事务部医疗服务提供者对将退伍军人转至社区医疗服务提供者处表示保留意见。
“选择计划”有可能增加退伍军人获得HCV治疗的机会，但退伍军人和退伍军人事务部医疗服务提供者表示在该计划实施的最初几年存在诸多重大问题。加强医疗服务协调、纳入共同决策以及建立广泛的社区医疗服务提供者网络，可能是为有需要的退伍军人设计基于社区的专科服务时进一步发展的重要领域。
