Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis.
Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis.
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DOI：
10.1002/acr.23088
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发表时间：
2017-06
影响因子：
4.7
通讯作者：
Barton J
中科院分区：
文献类型：
--
作者：
Schwab P;Sayles H;Bergman D;Cannon GW;Michaud K;Mikuls TR;Barton J
许多在退伍军人事务部（VA）登记的退伍军人也通过其他医疗保健系统接受护理。因此，在对这一人群进行研究时，必须考虑退伍军人和非退伍军人的医疗保健使用。本研究描述了类风湿关节炎（RA）退伍军人的双重护理使用情况，并探讨了与RA疾病活动性的关系。通过向三个VA站点的RA患者邮寄问卷，退伍军人报告了非VA初级保健和亚专科提供者的医疗服务，合并症，非VA药物和住院情况。在VA门诊就诊期间记录疾病活动评分(DAS)-28和多维健康评估问卷（MD-HAQ），并对应答组进行比较。在接受调查的510名参与者中，318人（62%）做出了回应。受访者年龄较大（69岁对66岁，p=0.006），不吸烟的可能性较大（80%对67%，p=0.001），疾病活动性较低（DAS-28 3.3对3.8,p<0.001; MD-HAQ 0.8对0.9,p=0.01），而非受访者（n=192, 38%）。非退伍军人服务提供者的受访者（n=130, 41%）比非双重护理使用者年龄更大（71岁对68岁，p=0.001），受教育程度更高（14岁对13岁，p=0.021）。只有6%的受访者报告有一个非va风湿病学家；2%的患者接受非va处方的生物制剂或改善疾病的抗风湿药物。在这项研究中，患有RA的VA受益人的双重护理利用率低于之前报道的普通VA人群，很少有患者接受双重风湿病治疗或非VA RA药物治疗。这项调查表明，大多数美国退伍军人与风湿性关节炎谁获得退伍军人事务部的护理使用退伍军人事务部作为他们的关节炎护理的主要来源。
Many veterans enrolled in Veterans Affairs (VA) also receive care through other healthcare systems. Both VA and non-VA healthcare use must therefore be considered when conducting research in this population. This study characterized dual care utilization in veterans with rheumatoid arthritis (RA) and explored associations with RA disease activity. Through a questionnaire mailed to RA patients at three VA sites, veterans reported medical services by non-VA primary care and subspecialty providers, comorbidities, non-VA medications, and hospitalizations. Disease activity score (DAS)-28 and Multidimensional Health Assessment Questionnaire (MD-HAQ) were recorded during VA clinic visits, and respondent groups compared. Of the 510 participants surveyed, 318 (62%) responded. Respondents were older (69 vs. 66 years, p=0.006), more likely non-smokers (80% vs. 67%, p=0.001) and had lower disease activity (DAS-28 3.3 vs. 3.8, p<0.001; MD-HAQ 0.8 vs. 0.9, p=0.01) than non-respondents (n=192, 38%). The respondents with a non-VA provider (n=130, 41%) were older (71 vs. 68 years, p=0.001) and had more education (14 vs. 13 years, p=0.021) than non-dual care users. Only 6% of respondents reported having a non-VA rheumatologist; with 2% receiving a non-VA prescribed biologic or disease-modifying anti-rheumatic drug. In this study, VA beneficiaries with RA had lower dual-care utilization than previously reported for the general VA population, with few patients receiving dual rheumatology care or non-VA RA medications. This survey suggests that most US Veterans with RA who access VA care use the VA as their primary source of arthritis care.