Pope Charlene A, Davis Boyd H, Wine Leticia, Nemeth Lynne S, Haddock K Sue, Hartney Tom, Axon R Neal
1 Health Equity & Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs (VA) Medical Center, Charleston, SC, USA.
2 Division General Pediatrics, Department of Pediatrics, College of Medicine, Medical University of South Carolina (MUSC), Charleston, USA.
Chronic Illn. 2018 Dec;14(4):283-296. doi: 10.1177/1742395317729887. Epub 2017 Sep 14.
This study explores perceptions of US Veterans Affairs (VA) and non-VA healthcare providers caring for Veterans with heart failure (HF) regarding Veteran knowledge and motivations for dual use, provider roles in recommending and coordinating dual use, systems barriers and facilitators, and suggestions for improving cross-system care.
Twenty VA and 11 non-VA providers participated in semi-structured interviews, which were analyzed using parallel qualitative content and discourse analysis.
VA and non-VA providers described variable HF knowledge and self-management among Veterans, and both groups described the need for improved education addressing medication adherence, self-care, and management of acute symptoms. Both groups described highly limited roles for providers in shaping choices surrounding dual use. VA and non-VA providers had significantly different perceptions regarding the availability, quality, and effectiveness of VA HF services. Multiple non-VA providers expressed frustration with and difficulty in contacting VA providers, accessing records, and making referrals into the VA system. Suggestions for improved care focused on patient education and care coordination.
Dual healthcare system use for Veterans is increasingly common. Similarities and contrasts in perceptions of VA and non-VA providers are instructive and should be incorporated into future policy and program initiatives.
本研究探讨美国退伍军人事务部（VA）和非退伍军人事务部的医疗服务提供者在照顾心力衰竭（HF）退伍军人方面，对退伍军人关于双重用药的知识和动机、提供者在推荐和协调双重用药方面的作用、系统障碍和促进因素，以及改善跨系统护理的建议的看法。
20名退伍军人事务部提供者和11名非退伍军人事务部提供者参与了半结构化访谈，采用平行定性内容和话语分析方法进行分析。
退伍军人事务部和非退伍军人事务部的提供者描述了退伍军人之间不同的心力衰竭知识和自我管理情况，两组都表示需要改进针对药物依从性、自我护理和急性症状管理的教育。两组都描述了提供者在影响双重用药相关选择方面的作用非常有限。退伍军人事务部和非退伍军人事务部的提供者对退伍军人事务部心力衰竭服务的可及性、质量和有效性的看法存在显著差异。多名非退伍军人事务部的提供者表示在联系退伍军人事务部的提供者、获取记录以及向退伍军人事务部系统转诊方面感到沮丧和困难。改善护理的建议集中在患者教育和护理协调上。
退伍军人使用双重医疗系统的情况越来越普遍。退伍军人事务部和非退伍军人事务部提供者看法中的异同具有指导意义，应纳入未来的政策和项目举措中。
