Differences in Bladder Care for Veterans with Multiple Sclerosis by Treatment Location

Abstract

Previous work suggested that veterans with multiple sclerosis (MS) treated through the Veterans Health Administration (VHA) had greater access to multidisciplinary care than veterans treated elsewhere. It is unknown whether other VHA-related differences in processes of MS care exist. Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we aimed to compare bladder management reported by veterans who receive care through the VHA (VHA veterans) and those who do not (non-VHA veterans). In 2005, NARCOMS participants completed the Urogenital Distress Inventory–6 (UDI-6) and reported urologic investigations and treatments. Using multivariable logistic regression, we assessed the independent association of VHA care with investigations or treatments. A total of 1247 veterans with MS responded to the questionnaire, of whom 1230 (98.6%) reported where they received their health care. Of these, 583 (47.4%) received some or all of their care through the VHA. After adjustment for demographic and clinical factors, VHA veterans more frequently reported undergoing urologic investigations than non-VHA veterans (adjusted odds ratio, 2.02; 95% confidence interval, 1.55–2.61). VHA veterans more frequently reported using pharmacologic and nonpharmacologic interventions than non-VHA veterans. Differences exist in the processes of MS bladder care between the VHA and elsewhere; this variation suggests the availability of opportunities to optimize such care.