Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

Christine A Elnitsky,Elena M Andresen,Carmen G Hall,Robert D Kerns,Michael E Clark,Suzanne Mcgarity

doi:10.1186/1472-6963-13-498

Abstract

BackgroundThe U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans.MethodsWe studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care.ResultsNearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees’ odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee’s odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care.ConclusionsThis study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to receiving services exclusively from the VA, including mutable health delivery system factors.

Highlights

The U.S Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq
To examine the extent to which barriers to VA care influence actual use of VA health care, we conducted a series of logistic regressions in which we examined the unique contribution of care system and other factors to VA use
The average length of deployment to Operation enduring freedom (OEF)-Operation Iraqi Freedom (OIF) was approximately 15 months, 80.2% reported they had been exposed to blasts, and 65.2% were receiving VA benefits for service connected conditions

Summary

Introduction

Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans. Many veterans of Afghanistan and Iraq have experienced exposure to blasts and explosions, resulting in multiple complex injuries to body systems, emotional distress and mental disorders, [1,2] and pain [3,4,5]. Among OEFOIF war veterans, there is a high prevalence of Post Traumatic Stress Disorder (PTSD) [1,2,6] which often occurs in tandem with pain [7]

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Discussion

Conclusion