Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment.
Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment.
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DOI：
10.3122/jabfm.2021.02.200332
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发表时间：
2021-03
影响因子：
2.9
通讯作者：
Boockvar, Kenneth
中科院分区：
文献类型：
--
作者：
Augustine, Matthew R.;Mason, Tanieka;Baim-Lance, Abigail;Boockvar, Kenneth
关键词：
城市中的老年退伍军人对退伍军人事务部(VA)医疗保健的依赖较少，这表明老年退伍军人缺乏获得和服务的机会。我们的目的是找出老年人城市退伍军人健康状况中使用VA和非VA的原因。我们检查了177名退伍军人的开放式回复，这些退伍军人在布朗克斯退伍军人医疗中心登记参加初级保健，在之前的两年中使用非退伍军人护理，并在2016年3月至2017年8月的护理协调试验中完成了基线访谈。使用内容分析，我们将关键术语和概念编码并分类到一个已建立的访问框架中。这一框架包括五个类别：可接受性(关系、第二意见)、可及性(距离、旅行)、可负担性、可获得性(供应、特殊护理)和住宿(组织、等待时间)。自我报告的健康状况按优秀/非常好、良好和一般/差进行分层。我们能够对166名退伍军人的反应进行分类，他们的年龄较大(≥75岁，61%)，少数族裔和民族(77%)，以及低收入(25,000美元/年，51%)。退伍军人提到的可接受性(42%)和可获得性(37%)最多，其次是可负担性(33%)、可用性(25%)和住宿(11%)。由于自我报告的健康状况较差，可获得性增强(优秀/非常好，24%；一般/较差，46%；p=0.031)，特别是在少数族裔退伍军人中，但可接受性仍然很高(优秀/很好，49%；一般/较差，37%；p=0.25%)。其他类别的提及较少，在不同健康状况下没有显著差异。即使在城市环境中，距离也是一个健康状况较差的主要问题。为年长、病情较重的退伍军人解决城市可达性和协调性问题，可能会加强对日益脆弱的退伍军人的护理。
Older veterans in urban settings rely less on Department of Veterans Affairs (VA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VA and non-VA use across health status of older, urban-dwelling veterans. We examined open-ended responses from 177 veterans who were enrolled in primary care at the Bronx VA Medical Center, used non-VA care in prior 2 years, and completed baseline interviews in a care coordination trial from March 2016 to August 2017. Using content analysis, we coded and categorized key terms and concepts into an established access framework. This framework included five categories: acceptability (relationship, second opinion), accessibility (distance, travel); affordability; availability (supply, specialty care); and accommodation (organization, wait-time). Self-reported health status was stratified by excellent/very good, good, and fair/poor. We were able to categorize the responses of 166 veterans, who were of older age (≥75 years, 61%), minority race and ethnicity (77%), and low income (<$25,000/year, 51%). Veterans mentioned acceptability (42%) and accessibility (37%) the most, followed by affordability (33%), availability (25%), and accommodation (11%). With worse self-reported health status, accessibility intensified (Excellent/very good, 24%; Fair/Poor, 46%; p=0.031) particularly among minority veterans, while acceptability remained prominent (Excellent/very good, 49%; Fair/Poor, 37%; p=0.25). Other categories were mentioned less with no significant difference across health status. Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VA population.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
退伍军人管理初级保健的更大连续性是否会减少老年退伍军人的急诊就诊和住院治疗？
影响因子：
6.3
作者：
Katz DA;McCoy KD;Vaughan-Sarrazin MS
通讯作者：
Vaughan-Sarrazin MS
影响因子：
5.7
作者：
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通讯作者：
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影响因子：
9.9
作者：
Crawford, Eean R.;Reeves, Cody J.;Astrove, Stacy L.
通讯作者：
Astrove, Stacy L.
影响因子：
39
作者：
Nyweide, David J.;Anthony, Denise L.;Fisher, Elliott S.
通讯作者：
Fisher, Elliott S.