Abstract
Many veterans receive care from both the Veterans Health Administration (VHA) and the non-VHA health system, or dual care.
Non-federal physicians practicing in Nebraska were surveyed to examine their perspectives on the organization and delivery
of dual care provided to veterans. A paper-based survey was mailed to all 1,287 non-federal primary care physicians (PCPs)
and a purposive sample of 765 specialist physicians practising in Nebraska. Rural physicians are more likely to incorporate
care coordination practices in their clinical practice, compared to urban physicians. More rural physicians report difficulties
in patient transfers, and referrals to the VHA, in prescribing for veteran patients, and in contacting a VHA provider in an
emergent situation regarding their veteran patient. More PCPs also report difficulties in referrals to the VHA. However, more
rural and primary care physicians follow up with their veteran patients post referral to the VHA. There was agreement among
the physicians that the current dual care system needed improvements to provide timely, efficient, coordinated and high quality
care to veterans. The specific areas identified for improvement were coordination of care, information sharing, medication
management, streamlining of patient transfers, reimbursement for care provided outside the VA, and better delineation and
clarity of the boundaries of each system and roles and responsibilities of VA and non-VA providers in the care of veterans.
Non-federal physicians practicing in Nebraska were surveyed to examine their perspectives on the organization and delivery
of dual care provided to veterans. A paper-based survey was mailed to all 1,287 non-federal primary care physicians (PCPs)
and a purposive sample of 765 specialist physicians practising in Nebraska. Rural physicians are more likely to incorporate
care coordination practices in their clinical practice, compared to urban physicians. More rural physicians report difficulties
in patient transfers, and referrals to the VHA, in prescribing for veteran patients, and in contacting a VHA provider in an
emergent situation regarding their veteran patient. More PCPs also report difficulties in referrals to the VHA. However, more
rural and primary care physicians follow up with their veteran patients post referral to the VHA. There was agreement among
the physicians that the current dual care system needed improvements to provide timely, efficient, coordinated and high quality
care to veterans. The specific areas identified for improvement were coordination of care, information sharing, medication
management, streamlining of patient transfers, reimbursement for care provided outside the VA, and better delineation and
clarity of the boundaries of each system and roles and responsibilities of VA and non-VA providers in the care of veterans.
- Content Type Journal Article
- Category Original Paper
- Pages 1-13
- DOI 10.1007/s10900-012-9604-6
- Authors
- Preethy Nayar, Department of Health Services Research and Administration, College of Public Health, 984350, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA
- Anh T. Nguyen, Department of Health Services Research and Administration, College of Public Health, 984350, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA
- Diptee Ojha, Department of Health Services Research and Administration, College of Public Health, 984350, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA
- Kendra K. Schmid, Department of Biostatistics, 984375, Nebraska Medical Center, Omaha, NE 68198-4375, USA
- Bettye Apenteng, Department of Health Services Research and Administration, College of Public Health, 984350, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA
- Peter Woodbridge, Department of Health Services Research and Administration, College of Public Health, 984350, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA
- Journal Journal of Community Health
- Online ISSN 1573-3610
- Print ISSN 0094-5145