Civilian Health Care Research Articles

Cold stored platelets in treatment of bleeding

The success of whole blood transfusion in military operational settings has engaged a debate on reintroduction of cold‐stored whole blood in treatment of critical bleeding in civilian health care. The haemostatic function of platelets stored cold at 4°C has however been questioned. In this review, we discuss the effects of cold storage on platelets, whether stored in whole blood or as platelet concentrates. Cold storage of platelets was abandoned during the 1970s due to reduced circulation time. Haemostatic superiority of cold‐stored platelets was however suggested. In vitro studies show reduced risk of bacterial contamination and equal or superior haemostatic qualities in cold‐stored platelet concentrates when evaluated by metabolic measures and aggregation response. Data on cold‐stored platelet concentrates from thrombocytopenic patients and healthy volunteers indicate improved platelet aggregation and reduced bleeding. A randomized controlled trial in paediatric patients undergoing cardiac surgery, showed reduced blood loss and improved platelet aggregation responses after transfusion with whole blood stored cold for up to 48 h, and platelets stored cold within whole blood for up to 15 days provide similar post‐storage platelet viability as platelet concentrates or apheresis platelets stored for less than 3 days. Animal studies also suggest efficacy of cold‐stored platelets. A study investigating the effects of cold‐stored apheresis platelets in patients undergoing cardiothoracic is currently being performed in Bergen, Norway showing promising results. We conclude that in vitro and clinical studies indicate that cold‐stored platelets may be beneficial in treatment of critical bleeding.

Role of tertiary care institutions for preventive activities for positive health: an exploratory study among defence and civilian health care facilities of Bangalore

Background: Health sector in India is facing several challenges. These can be attributed to population, poverty, illiteracy, poor social indices, poor patient to hospital ratio and inadequate government spending. Preventive activities for positive health by the various tertiary care institutions play a crucial role in mitigating some of the problems. The study was undertaken to assess the preventive services for positive health among tertiary care institutions of defence and civilian HCFs in Bangalore. Methods: Study was conducted by interacting with the key respondents of defence, government and private tertiary care hospitals. Using structured checklist, activities pertaining to preventive services promoting positive health was assessed. Results: Study shows that preventive health activities are being undertaken in all the sectors. There is varying degrees of effectiveness of implementation of the programs. Defence sector has maximised the service delivery and coverage, while Government sector delivers the preventive services through its outreach and national program implementation drive. In case of Private sector, though the focus is largely on curative care, preventive health services are being undertaken in a fragmented manner. Conclusions: Preventive activities for positive health can be optimally utilized and implemented by having coordination and cross-sectorial linkages of services. All the teaching hospitals and government hospitals may undertake these programs in a more systematic manner. Sharing of experiences and research between sectors in optimum provision of preventive services, may help in curtailing the increasingly expensive healthcare costs and improve the health of the communities.

DHA Director Describes Integration of Military Health Care Services

Back to table of contents Previous article Next article Professional NewsFull AccessDHA Director Describes Integration of Military Health Care ServicesMark MoranMark MoranSearch for more papers by this authorPublished Online:5 Jul 2017https://doi.org/10.1176/appi.pn.2017.7a12AbstractVice Adm. Raquel Bono directs an agency mandated to standardize best health care practices across military service lines and create a more globally integrated health care system. “We are strongest when we work together across service lines,” said Navy Vice Adm. Raquel Bono, director of the Defense Health Agency (DHA). “As a surgeon, I am not going to ask for a scalpel in a different way because the patient is in the Army or the Navy. Our common mission is the patient we serve, regardless of what kind of boots he or she wears.” Raquel Bono, M.D., said the military seeks the expertise of psychiatrists in the civilian sector in treating the “invisible wounds of war.”David HathcoxBono made her remarks at APA’s 2017 Annual Meeting in San Diego, where her theme was partnerships—across military service lines and, importantly, with physicians in the civilian sector.“As director of the DHA, I have the opportunity to oversee where our best practices are occurring and work to expand, integrate, and standardize those practices across the military,” Bono said. “If we do this the right way, we have a real opportunity to create a robust system serving all of our military service men and women and their families.”Bono said that the integration of health care across service lines is codified now in the most recent National Defense Authorization Act. Under the law, the mission of the DHA is to do the following: Create a more globally integrated health system, accountable as a combat support agency.Direct enterprise-wide shared services, standardizing clinical and business practices that produce better health and better care. Manage TRICARE for 9.4 million beneficiaries around the world. TRICARE is the health care program for uniformed service members and their families around the world.Deliver coordinated health care and support high-quality coordinated care in all multiservice markets.Regarding the visible wounds of battle, Bono said that the integration of the services is producing results. In the years since the wars in Afghanistan and Iraq started, the case fatality rate per battle injury has dropped. The invisible wounds have been more challenging. Bono solicited the help of psychiatrists in the civilian community to treat returning soldiers with traumatic brain injury and posttraumatic stress disorder. “We are very concerned about the suicide rate,” she said. “We are not dealing with a single, unitary phenomenon, but one that is very complex depending on the individual. We recognize that we don’t have all the answers, and we can’t do it alone. Partnering with others is going to be invaluable.” Vice Adm. Bono brings to her role a distinguished career in medicine and the military. She obtained her baccalaureate degree from the University of Texas at Austin and attended medical school at Texas Tech University. She completed a surgical internship and a general surgery residency at Naval Medical Center Portsmouth and a trauma and critical care fellowship at the Eastern Virginia Graduate School of Medicine in Norfolk. Shortly after training, Bono saw duty in Operations Desert Shield and Desert Storm as head of Casualty Receiving at Fleet Hospital 5 in Saudi Arabia from August 1990 to March 1991. Upon returning, she was stationed at Naval Medical Center Portsmouth as a surgeon in the General Surgery Department and attending surgeon at the Burn Trauma Unit at Sentara Norfolk General Hospital. Before becoming the director of the DHA, Bono served as director of the National Capital Region Medical Directorate of the DHA and as the 11th Chief of the Navy Medical Corps from September 2013 to October 2015.Bono said military and civilian health care providers share a common overarching mission and have much to offer each other. The military is prepared to reach out to the civilian sector, she said, such as when Patrick Downes and Jessica Kensky—victims of the 2013 Boston Marathon bombing—were invited to Walter Reed National Military Army Hospital in Washington, D.C., and partnered with “battle buddies” who had lost limbs in battle. Bono showed a video clip of a moving interview with Downes, who said, “We feel like we were embraced by the military family in a home that was meant for them.”Said Bono: “We have a sacred mission to care for our military service men and women and their families, but we also have a mission to share our experience and expertise with others. We hope you will share your experience and expertise with us.” ■ ISSUES NewArchived

Non-medical aspects of civilian\u2013military collaboration in management of major incidents

PurposeDisasters and major incidents demand a multidisciplinary management. Recent experiences from terrorist attacks worldwide have resulted in a search for better assessment of the needs, resources, and knowledge in the medical and non-medical management of these incidents and also actualized the need for collaboration between civilian and military healthcare. The aim of this study was to evaluate the impact of the civilian–military collaboration in a Swedish context with the main focus on its non-medical management.MethodAn exercise, simulating a foreign military attack centrally on Swedish soil, was designed, initiated, and conducted by a team consisting of civilian and military staff. Data were collected prospectively and evaluated by an expert team.ResultsSpecific practical and technical issues were presented in collaboration between civilian and military staffs. In addition, shortcomings in decision-making, follow-up, communication, and collaboration due to prominent lack of training and exercising the tasks and positions in all managerial levels of the hospital were identified.ConclusionCurrent social and political unrests and terror attacks worldwide necessitate civilian–military collaboration. Such collaboration, however, needs to be synchronized and adjusted to avoid preventable medical and non-medical consequences. Simulation exercises might be one important source to improve such collaboration.

Review of military and civilian trauma registries: Does consensus matter?

Structural collection of data from combat injuries is important to improve provided care and the outcome of (combat) casualties. Trauma registries are used in civilian and military health care systems for systematic administration of injury data. However, these registries often use different methods of data management, compromising international comparison of trauma systems. The aim of this review is to aid in reaching international (coalition-wide) consensus for compatible data collection methods with uniform definitions, which is needed for transnational research and subsequent improvement of medical support organizations. In this descriptive review, we analyzed different data sets from trauma systems within the American-European context, and included data variables from civilian and military trauma registries. These data sets were analyzed to identify a core set of variables fundamental to describing the tactical context, epidemiology, injury mechanism, injury severity, key treatment, and outcome. A total of 1,672 unique variables, of which 536 military specific, were identified and divided in 11 elemental categories of medical care (patient info, incident info, injury diagnoses, prehospital care, emergency department, imaging, surgical treatment, intensive care, ward, discharge and outcome) and three military-specific categories (forward medical evacuation, prehospital medical treatment facility, and discharge out of theater). A total of 203 key variables were identified and considered fundamental for effective (military) trauma research. Well-established and reliable trauma registries and databases are fundamental in (military) trauma care. We recommend implementation of a (concurrent) UN/NATO wide registry system with a track and follow-up system to further improve the quality of care and registration of casualties. Further research should focus on real time aids available on the battlefield and direct storage/upload in trauma databases in theater. Ultimately, sound and valid data support medical decision process and evaluation necessary to save lives on the battlefield.

Improving Surgical Complications and Patient Safety at the Nation's Largest Military Hospital: An Analysis of National Surgical Quality Improvement Program Data.

The U.S. Military Health System cares for over 9 million patients and encompasses 63 hospitals and 413 clinics worldwide. Military medicine balances the simultaneous tasks of caring for those patients wounded in military engagements, treating large numbers of families of service men and women, and training the next generation of health care providers and ancillary staff. Similar to civilian health care delivery in the United States, military medicine has also seen increased scrutiny in the areas of cost and quality. In 2014, the U.S. military medical health care system was criticized for higher than average surgical complication rates and concerns regarding patient safety, quality of care, lack of transparency, and compartmentalized leadership. The San Antonio Military Medical Center was specifically cited as having "a perennial problem with surgical infection control…the infection rate of surgical wounds was 77% higher than expected given the mix of cases, according to a Pentagon-ordered comparison with civilian hospitals." To determine the scope of complication rates, data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were analyzed. The goal of this article is to describe the NSQIP surgical outcome data for the U.S. Military's largest medical center from 2009 to 2014 and compare national averages in the areas of mortality, morbidity, cardiac occurrences, pneumonia, unplanned intubation, ventilator use greater than 48 hours, infections, readmissions, and return to operating room. Retrospective data analysis of NSQIP data from 2009 to 2014 at the San Antonio Military Medical Center, a level I trauma center for military members and eligible dependents along with civilian trauma patients. Observed event rates were compared with expected event rates for each year with the 2-tail Fisher's exact test to determine if rates were significantly different from each other. Cochran-Armitage Trend Test was performed to compare trends in time for the observed event rates. This study was exempt from institutional review board Approval. Complication rates remained stable or decreased over the 5 years studied. Significant improvement in morbidity and surgical site infections were observed during the observation period. All other variables except urinary tract infections were within expected range or decreased during this time. Urinary tract infection rates, although decreasing, remain above the expected value. NSQIP data at the Department of Defense's largest hospital reveals complication rates similar to civilian hospitals. The majority of areas studied revealed improving or stable complication rates. The ACS NSQIP is a nationally validated, risk-adjusted, outcomes program that is widely used by many leading hospital institutions. Similar to most quality data reporting articles, a weakness of our study may have been collection of all complications. Yet, we are confident that the majority of complications were captured as we have dedicated personnel monitoring the adverse events measured by ACS NSQIP. Future areas of study should focus on continued analysis of surgical quality improvement within the entire military system.

Empirical Study on the Impact of a Tactical Biosurveillance Information Visualization on Users' Situational Awareness.

Decisions on antibiotic-resistant infection (ARI) prevention in dynamic health care settings should be agile and target the right process at the right time. Health information technologies can aid the recognition of high-risk situations for ARI transmission and timely facilitate operators' situational awareness (SA) in various military and civilian health care locations or transport platforms. High SA is one of the significant predictors of better performance. The objective of this study was to evaluate the impact of the developed health information visualization (VIZ) on the users' SA regarding situations when risks of ARI transmission and exposure are high. The enrolled 19 subjects assessed the proposed VIZ artifacts representing 1 scenario, compared the VIZ effectiveness against the currently employed local methods, and reported their SA (perception and comprehension) with the use of a pre- and post-self-rating questionnaire. The results showed that the VIZ significantly increased SA in the study subjects and revealed the importance of communicating the risk of exposure to ARIs. The VIZ enabled the participants to quickly acknowledge the high-risk individuals (super-spreaders), locations (hot spots), and biosafety (deficient infection prevention). The study concluded that SA-oriented technologies may be promising for promoting better infection prevention practices.

Abstract TMP79: Does Race or Socioeconomic Class Matter in Socialized Medicine? A Retrospective Analysis of Stroke cost and outcomes in US Military Health Care System

Introduction: The racial disparity of stroke outcomes is well documented in the US Civilian Healthcare system. In contrast, the Military Healthcare system is a single payer system (Every member has the same health benefits). Does this affect outcomes? Hypothesis: We hypothesize there will be no difference in Healthcare outcomes within the Military Healthcare system when the effects of race and rank (socioeconomic surrogate) are considered. Methods: Data was collected from the Defense Health Agency Military Mart (M2) database from fiscal year 2010 to 2016 (All admissions to military care facilities). The M2 database stores data including rank and race. Adult patients with a primary diagnosis of stroke at discharge (International Classification of Diseases, 9th Revision codes 434.91, 434.11 or 10 th Revision code I63.9) were reviewed. Race and Rank were compared for Duration of hospitalization, total Cost of the hospitalization and Outcome (disposition status) using Multivariate Analysis. Results: A total of 3,910 patients discharged from Military hospitals were identified. The racial composition of this sample was: White 50.1%, Black 17.3%, Asian 7.2%, Other 2.9%, and Unknown/Not Reported 22.5%. There was no correlation between race and Duration of hospitalization, total Cost of the hospitalization or Outcome. Military Rank was identified with 2,134 (54.6%) of the 3,910 patients in the study. The Rank identified study population was: Senior Enlisted 71.4%, Senior Officers 18.2%, Junior Enlisted 4.9%, Junior Officers 2.9% and Warrant Officers 2.5%. There was no correlation between Rank and Duration of hospitalization or total Cost of the hospitalization. There was a statistically significant trend to better Outcome for higher rank then lower (p<0.05). Conclusions: Racial disparities evident in the Civilian Healthcare system do not appear to transfer to the Military Healthcare system. Rank (as a socioeconomic surrogate) did have a trend toward better Outcomes with higher rank.

Staff Attitudes Regarding the Impact of a Therapy Dog Program on Military Behavioral Health Patients.

Human-animal interactions in the form of animal-assisted therapy (AAT) have become common in both civilian and military health care facilities. Evidence supports AAT as a beneficial therapeutic alternative for patients with physical disabilities and psychological disorders. Few studies have been conducted in the civilian health care setting to evaluate staff attitudes regarding the impact of an AAT program on behavioral health (BH) patients. To our knowledge, no research has examined staff attitudes on the impact and effectiveness of AAT on active-duty Servicemembers in a BH program at a military facility. At the completion of a year-long AAT dog program and after institutional review board exemption, an anonymous, six-question survey was used to examine staff attitudes (n = 29) regarding the impact and continuation of the program with military BH patients. Most staff members (86%) believed the AAT dog program had a positive impact on the BH patients, including improved patient mood, greater patient relaxation, improved patient attitude toward therapy, and increased social interactions among patients. All the staff reported a desire to continue the program at the military facility. Most BH staff thought the year-long AAT dog program had a positive impact on patients. All staff supported continuation of the program.

DEFINING REQUIREMENTS TO MEDICAL WASTE HANDLING ON BOARD NAVY SHIPS

The present article presents data relevant to addressing the issues of medical and biological waste handling in civilian and naval health care and on board of navy ships in the Russian Federation. It is shown that many of the juridical and technological issues of on-board treatment of medical and biological waste generated during regular exploitation of vessels and upon possible emergency situations are still unresolved in the Navy of the Russian Federation. The analysis of available data suggests that the technologies of waste neutralization, elimination, storage, and deposition currently used in the health care system of the Russian Federation are suitable in the Navy.

The Highest-Impact Combat Orthopedic and Extremity Injury Articles in the Past 70 Years: A Citation Analysis.

The objective of this study was to identify the most-cited peer-reviewed combat orthopedic and extremity injury articles published during the past 70 years. Orthopedic trauma presents ongoing challenges to both US civilian and military healthcare personnel. Improvements in combat trauma and extremity injury survival and quality of life are the result of advances in orthopedic trauma research. The Web of Science (including Science Citation Index) was searched for the most cited articles related to combat orthopedic trauma, published from 1940 to 2013. The most-cited article was by Owens et al. (Journal of Orthopaedic Trauma, 2007; 137 citations). Between the 1990s and 2000s, there was a 256% increase in the number of highly cited publications. A total of 69% of the articles were on the topics of comorbid vascular trauma (25%), epidemiology (23%), or orthopedic trauma (21%). This study identifies some of the most important contributions to combat orthopedic trauma and research and the areas of greatest scientific interest to the specialty during the past seven decades and highlights key research that has contributed to the evolution of modern combat orthopedic traumatology.

Becoming an Air Force Nurse: The Experience of Transition A New Perspective of a Known Phenomenon.

Transitions in nursing have consistently been described as complex and stressful. While the literature is replete with studies investigating role transitions in civilian healthcare settings, there is no known research that explores the role transition of experienced nurses who move from civilian to military nursing practice. Using nurses in the U.S. Air Force as an exemplar, this study serves as a starting point to understand the transition process and challenges likely encountered by nurses new to the military. The outcomes of this study could influence future efforts to recruit and retain qualified nurses. A hermeneutic, phenomenologic approach was used to explore and describe the lived experience of transition from civilian staff nurse to Air Force staff nurse. The results indicated that new Air Force nurses encounter challenges related to a lack of knowledge and role preparedness, which led to feelings of stress and frustration. Support from peers, mentors, and managers helped the new Air Force nurses bridge the gap in knowledge and successfully integrate into the military culture. Efforts to reduce the perceived lack of knowledge through improvements to the Commissioned Officer Training program and the clinical orientation period are recommended.

Transitioning Former Military Medics to Civilian Health Care Jobs: A Novel Pilot Program to Integrate Medics Into Ambulatory Care Teams for High-Risk Patients.

Despite their medical training, record of military service, and the unmet needs within the health care sector, numerous challenges face veterans who seek to leverage their health care skills for employment after leaving the military. Creative solutions are necessary to successfully leverage these skills into jobs for returning medics that also meet the needs of health care systems. To achieve this goal, we created a novel ambulatory care health technician position on the basis of existing literature and modeled after a program which incorporates former military medics in emergency departments. Through a quality improvement approach, a position description, interview process, training program with clinical competencies, and team integration plan were developed and implemented. To date, two medics have been hired, successfully trained on relevant skill sets, and are currently caring for medical outpatients (under the supervision of licensed clinical personnel) as crucial interdisciplinary team members. Taken together, a multifaceted approach is required to effectively harness military medics' skills and experiences to meet identified health delivery needs.

Capitalizing on Military Nurse Skills for Second-Career Leadership and Staff Development Roles.

Nursing continues to face professional workforce and diversity shortage problems. This article advocates for examining an untapped resource-the consideration of applicants for nursing leadership and educational positions in civilian health care organizations. This untapped resource is highly qualified, already retired (or going to be separated) military nurse officers (MNOs) who possess extensive health care knowledge, as well as distinctive ethnicity and gender composition. Clinical educators, as part of the organizational leadership, can play an important role in assisting the MNO civilian position assimilation because they come from a structured and unique cultural environment. Several innovative preparatory strategies are proposed to highlight the organization's support and commitment regarding preselection, recruiting, hiring, and mentoring, including the use of a specific navigational mentor to achieve the necessary acquired cultural assimilation for the MNO's success, satisfaction, and retention. J Contin Educ Nurs. 2016;47(11):503-510.

Where Do Soldiers Really Come From? A Faculty Development Workshop on Veteran-Centered Care.

Addressing the medical concerns of veterans in both civilian health care systems and the Veterans Affairs (VA) health care system, where staff are familiar with issues of military reintegration, remains difficult but is increasingly important. In 2013, the authors developed and implemented a faculty development workshop for practicing clinicians using the documentary Where Soldiers Come From. The workshop included topics on unconscious bias, the service member trajectory, health care disparities, and strategies for overcoming barriers to treating veterans with posttraumatic stress disorder and traumatic brain injury. The workshop engaged faculty in the following active-learning techniques: images in education; trigger video; critical thinking and reflective writing; think-pair-share; and large-group discussion. The workshop has been conducted at three locations with 46 health care professionals. Thirty-one of 37 (84%) participants who completed the workshop evaluation were VA employees. The evaluation results show 25/32 (78.1%) participants indicated the workshop activities changed their knowledge, attitudes, and/or skills; 22/34 (64.7%) stated they had a better understanding of how to develop a care plan for veterans; and 27/34 (79.4%) stated they gained a better understanding of how to prepare for issues around returning veterans. To address the issue of veteran-centered care education more broadly, the authors have developed a massive open online course for health professionals, using most of the content from this workshop, which will be offered in spring 2016. Another important next step will be to deliver this workshop to and collect evaluation data from non-VA providers.

The Character Strengths of Special Forces Personnel: Insights for Civilian Health Care Practitioners.

Civilian employees, contractors, and private community clinicians are increasingly providing health treatment to currently serving and former military personnel. This study addresses recent calls for evidence-based information to assist civilian practitioners in understanding the perspectives of their military clients. To this end, the self-reported character strengths of military personnel were elicited as an operationalized expression of their underlying personal values that shape their perspectives and conduct as soldiers. Specifically, Australian Army Special Forces operators and support personnel (N = 337) were asked to rank themselves on 24 character strengths. The three character strengths of integrity, teamworker, and good judgment were ranked significantly above random assignment. Nearly all the respondents (84%) gave a top rank to at least one of these character strengths. Differences between the operators and support personnel were modest. Results are discussed with respect to establishing an effective relationship between military clients and civilian health care practitioners.

Arthritis, comorbidities, and care utilization in veterans of operations enduring and Iraqi Freedom.

Veteran populations are known to have frequencies of arthritis higher than civilian populations. The aim of this study is to define the prevalence of arthritis among a cohort of veterans from ongoing U.S. military operations. A retrospective cohort study using Veterans Administration data sources for service connected disability, comorbidities, clinic utilization, and pharmacy utilization was conducted including veterans who deployed in service to operations in Afghanistan or Iraq, comparing veterans with a diagnosis of arthritis, arthritis plus back pain, and veterans with no pain diagnoses. The frequency of arthritis was 11.8%. Veterans with arthritis and arthritis plus back pain had greater frequencies of diabetes, hyperlipidemia, hypertension, and obesity compare to veterans with no pain diagnosis. Veterans with arthritis plus back pain had the highest pain clinic utilization and prescription use of opioids and anti-inflammatories. Veterans with no pain diagnosis had higher frequencies of diagnosis and clinic utilization for mental health disorders. Arthritis is prevalent among the latest generation of combat veterans and is associated with diabetes, obesity, and cardiovascular comorbidities. The need for arthritis care and associated comorbidities is expected to increase as the Veterans Administration and the civilian health care sector assumes care of these veterans. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:682-687, 2017.

Educating nurses to care for military veterans in civilian hospitals: An integrated literature review

BackgroundIn the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. AimTo conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. Review methodsA systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. ResultsThe search generated sixteen papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. ConclusionCivilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings.

Legislative: Providing Veteran-Specific Healthcare

There are currently 22 million veterans living in the United States. While 8.92 million veterans are enrolled in the Veterans Administration (VA) Health Care System, nearly 60% of veterans are relying on services outside the VA system (National Center for Veterans Analysis and Statistics, 2014). As such, it is imperative that civilian nurses understand service eligibility and veteran-foeused care for this unique population.It is a common misconception that all veterans are eligible to receive full healthcare benefits within the Veterans Health Administration (VHA). However, veterans are only eligible for health benefits if they meet specific requirements, such as certain minimum lengths of service and type of discharge as described below (Szvmendera, 2015). Due to the specificity of these requirements, as well as the complicated eligibility process for receiving care in the VHA system, less than half of veterans receive healthcare services within the VHA system (National Center for Veterans Analysis and Statistics. 2014). Health disparities among this population have been well documented (Montgomery, Dichter, Thomasson, Roberts. & Byrne, 2015). Additionally, with the introduction of the Veterans Choice Act in 2014, veterans increasingly are accessing civilian healthcare services (VA. 2014).Today nurses are at the forefront of the healthcare delivery system and are often the first to provide services to veterans. As nurses, we must be prepared to assist veterans in determining eligibility and understand how to help veterans navigate the VA system, so as to increase their access to care. A better understanding of this process can ensure high quality, veteran-specific patient care, and potentially decrease the health disparities within the veteran population.Determining Veteran Status and EligibilityThe VA offers a variety of benefits to veterans of the armed forces, including multiple types of financial assistance, healthcare, housing, and education (Szvmendera, 2015). To be eligible for benefits, a former service member who enlisted after September 8, 1980, must have served a minimum of twenty-four continuous months of active duty. There are no minimum service obligations prior to this date. However, health benefits for injuries incurred during active military service (service-connected disability) are exempt from this service obligation (Szvmendera. 2015). Discharge criteria require that an individual be released from military duty with either an honorable discharge or general discharge (Moulta-Ali 8i Pananoala, 2015). Although a dishonorable discharge automatically disqualifies an individual for VA benefits, other-than-honorable discharges or bad conduct discharges can be determined by special consideration (Moulta-Ali &. Pananoala. 2015).Once former service members are determined eligible for benefits, their healthcare services are provided under a component of the VA called the Veterans Health Administration (VHA). The VHA is an integrated health system comprised of VA medical centers (VAMCs), community based outpatient clinics (CBOCs), community living centers (CLCs), Vet centers, and domiciliaries across the United States (VA. 2016). Veterans can receive a variety of services including primary care, specialty care, mental healthcare, and rehabilitative services. In response to both the growing need for increased veterans' healthcare services and the rather recent whistleblower activity related to lengthy appointment wait times for veterans, the Veterans Choice Act was implemented in 2014. The Choice Act directs the Veterans Choice Program; this program allows for VA eligible veterans to receive non-VA care if they have to wait more than thirty days for VA care or if they live more than forty miles from the nearest VA medical facility (VA. 20141.Veteran-Specific HealthNeedsToday, in the United States, there are veterans seeking healthcare services who served during wartime and peacetime and from every major conflict since WWII. …

Implementation Of A Community Psychological Treatment Program For Military Families: Project Homefront

Demand for psychological services by the U.S. military population has outpaced supply in recent years. Despite record growth within the government health care systems in this area, roughly half of veterans have sought any healthcare within the Veterans Health Administration system. Civilian health care systems are often filling the void, particularly for military family members. This study used an implementation science approach to describe a civilian psychological treatment program for active duty service members (primarily Army) and their family members. Project Homefront provided free, unlimited and confidential mental health care in 2008-2012 – a time of rising suicide rates throughout the U.S. military. The program was grant funded. A considerable amount of work went into educating grant agencies and the public, while maintaining good working relationships with leadership on Fort Hood, in Central Texas. Fear of stigma was reduced with the use of community-based psychological care that maintained confidential patient records within a private electronic health record. Programmatic offerings evolved to accommodate the needs of those walking through the door: initially, mostly spouses, then later, when deployed units returned, mostly soldiers. A number of recommendations for how to coordinate fundraising, manage administrative infrastructure and reach out to the military community as a private health care entity are discussed.