Oregon Rural Practice Based Research Network, Portland, USA.
Oregon Health & Science University, Portland, USA.
J Gen Intern Med. 2024 Mar;39(4):596-602. doi: 10.1007/s11606-023-08442-7. Epub 2023 Oct 30.
The 2014 Veterans Choice Act and subsequent 2018 Veteran's Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans.
To understand Veterans' experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans.
Qualitative descriptive design.
United States (US) Veterans in Northwestern states engaged in VA and/or community care.
Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis.
We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women's healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation.
Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans-especially those with medical complexities, those living far from healthcare services, or those seeking women's healthcare.
2014 年《退伍军人选择法案》和随后的 2018 年《退伍军人事务部维护系统和加强综合外部网络法案》（MISSION 法案）是明确退伍军人获得非退伍军人临床医生（社区护理）提供的医疗保健的立法。这些政策对于居住在农村地区的退伍军人尤为重要，他们往往比城市退伍军人居住得离退伍军人医疗设施更远。
了解退伍军人对 MISSION 法案的体验，以及该法案如何影响他们获得初级保健，以便为今后的干预措施提供信息，重点是接触农村退伍军人。
定性描述设计。
参与退伍军人事务部和/或社区护理的美国西北部退伍军人。
对 2020 年 8 月至 2021 年 9 月期间的退伍军人进行了有针对性的半结构式访谈。访谈领域侧重于获取医疗保健的障碍和促进因素。使用主题分析对抄本进行分析。
我们采访了 28 名退伍军人；52%的人将社区护理作为他们的主要护理来源，36%的人来自农村或边疆地区。出现了三个主要主题：（1）退伍军人描述了他们的医疗保健体验是积极的，但也令人沮丧（计费和事先授权是他们最大的挫折）；（2）有医疗复杂情况、远离医疗服务和/或寻求妇女保健服务的退伍军人，由于与退伍军人事务部系统和流程的互动增加，经历了更多的挫折；（3）财务资源和/或对退伍军人事务部系统的了解使退伍军人免受医疗保健导航的挫折。
尽管 MISSION 法案有规定，但退伍军人参与者描述了持续存在的医疗保健获取障碍。需要与退伍军人事务部流程进行更多互动的患者特征使这些障碍恶化，而财务资源和退伍军人事务部系统知识则减轻了这些障碍。改善退伍军人事务部和社区护理环境中的医疗协调或解决获取障碍的干预措施可以改善退伍军人的医疗服务获取，并减少医疗保健方面的不平等，特别是对那些有医疗复杂情况、远离医疗服务或寻求妇女保健的退伍军人。
