From the Geriatric Research Education and Clinical Center (GRECC), James J Peters VA Medical Center, Bronx, NY (MRA, TM, AB-L, KB); Icahn School of Medicine at Mount Sinai, Department of Medicine, New York, NY (MRA); Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine, New York, NY (AB-L, KB); Community Wellness Department, Reading Hospital, Reading, PA (TM); Research Institute on Aging, The New Jewish House, New York, NY (KB).
J Am Board Fam Med. 2021 Mar-Apr;34(2):291-300. doi: 10.3122/jabfm.2021.02.200332.
Older veterans in urban settings rely less on the Veterans Health Administration (VHA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VHA and non-VHA use across the health status of older, urban-dwelling veterans.
We examined open-ended responses from 177 veterans who were enrolled in primary care at the Bronx VA Medical Center, used non-VHA care in prior 2 years, and completed baseline interviews in a care coordination trial from March 2016 to August 2017. Using content analysis, we coded and categorized key terms and concepts into an established access framework. This framework included 5 categories: acceptability (relationship, second opinion), accessibility (distance, travel); affordability; availability (supply, specialty care); and accommodation (organization, wait-time). Self-reported health status was stratified by excellent/very good, good, and fair/poor.
We were able to categorize the responses of 166 veterans, who were older (≥75 years, 61%), minority race and ethnicity (77%), and low income (<$25,000/y, 51%). Veterans mentioned acceptability (42%) and accessibility (37%) the most, followed by affordability (33%), availability (25%), and accommodation (11%). With worse self-reported health status, accessibility intensified (excellent/very good, 24%; fair/poor, 46%; = .) particularly among minority veterans, while acceptability remained prominent (excellent/very good, 49%; fair/poor, 37%; = .). Other categories were mentioned less with no significant difference across health status.
Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VHA population.
城市环境中的老年退伍军人对退伍军人健康管理局（VHA）的医疗保健的依赖程度较低，这表明老年退伍军人的获取途径和服务存在不足。我们旨在确定在城市老年退伍军人的健康状况下，使用 VHA 和非 VHA 的原因。
我们对 177 名在布朗克斯退伍军人医疗中心接受初级保健、在过去 2 年内使用过非 VHA 护理且在 2016 年 3 月至 2017 年 8 月期间完成了护理协调试验基线访谈的退伍军人的开放式回答进行了检查。我们使用内容分析法，将关键词和概念编码并分类到已建立的获取框架中。该框架包括 5 个类别：可接受性（关系、第二意见）；可及性（距离、旅行）；负担能力；可用性（供应、专科护理）；和适应性（组织、等待时间）。根据优秀/非常好、好和一般/差的自我报告健康状况对退伍军人进行分层。
我们能够对 166 名退伍军人的回答进行分类，这些退伍军人年龄较大（≥75 岁，61%），属于少数民族（77%），收入较低（<25,000 美元/年，51%）。退伍军人最常提到可接受性（42%）和可及性（37%），其次是负担能力（33%）、可用性（25%）和适应性（11%）。自我报告的健康状况越差，可及性问题越突出（优秀/非常好，46%；一般/差，46%； =.），特别是在少数民族退伍军人中，而可接受性仍然很突出（优秀/非常好，49%；一般/差，37%； =.）。其他类别则较少提及，健康状况之间没有显著差异。
即使在城市环境中，接近度也是一个主要问题，健康状况越差。为了满足城市环境中对老年、病情较重的退伍军人的需求，需要加强对不断增长的弱势群体的 VHA 人群的关怀。
