Study: Veteran Care a Unique Challenge to Non-VA Primary Care

'They Are Their Own Culture,' One Surveyed Physician Says

February 05, 2019 04:35 pm News Staff

With fewer than half of U.S. military veterans receiving care in the Department of Veterans Affairs (VA) system, primary care physicians outside the VA may have "great uncertainty" about how best to address veterans' needs.

[stethoscope and military id tags]

That's the conclusion of a study published in Family Practice(academic.oup.com) titled "Caring for veterans in U.S. civilian primary care: qualitative interviews with primary care providers."

"The civilian medical community in general is really in blissful ignorance of the changes that take place over the military training, and especially those men and women who've actually served in combat," one study participant -- a veteran himself -- told researchers.

The study centered on interviews with 10 non-VA primary care professionals -- physicians, nurse practitioners and physician assistants in Western New York -- and sought to identify training, tools and processes that might improve veteran care in primary care practices.  

Story Highlights
  • Authors of a study on primary care for veterans found that some physicians may have "great uncertainty" about how best to address veterans' needs.
  • Some veterans may see physicians in both Veterans Affairs and civilian facilities, leading to continuity of care problems.
  • The authors suggested further study "to understand how screening and follow-up care for veteran patients is best implemented into primary care settings."

The interviews led the study to three core themes:

  • New tools and practices could better screen for veteran status,
  • veterans sometimes present unique care challenges, and
  • these challenges call for "translating and implementing new care processes for veteran patients into everyday practice."

Those interviewed indicated a range of perceived barriers to providing good care for veterans, including

  • limited perception of the possible impact of veteran status and how it would change the provision of medical care,
  • inconsistent knowledge of military culture and population,
  • limited knowledge of community resources and support services, and
  • lack of coordination with the VA health system.

Often, a patient's veteran status isn't known to the physician -- though survey results from the same study, published by the authors in a separate article,(journals.stfm.org) indicated that knowing a patient's military status may not help them provide better care.

But what then?

At least one interviewee noted that medical school had offered no training specific to veterans' health on par with education available concerning ethics, cultural competence and other special populations. "And I think they (veterans) are their own culture," the interviewee said.

It's no small culture. As of 2015, some 20 million veterans lived in the United States, "comprising approximately 6 percent of the total population," the authors wrote.

Yet many service members are not eligible for benefits from the VA or Department of Defense, they added, "which necessitates these individuals be seen in civilian health care settings." And veterans living in rural areas distant from VA facilities also frequently use non-VA health care providers.

These factors contribute to an estimated veteran caseload in civilian settings of approximately 134 veterans per U.S. primary care doctor, according to one study(jaoa.org) cited by the authors. They added that "significant portions of veterans are also dual users of VA and civilian health care" -- raising continuity-of-care concerns.

"I think that's my biggest issue, is that there's zero communication between VA providers and primary care providers," one interviewee responded. "And it's like, 'Well, why am I repeating this test that you had done two months ago, but I just don't have the results and I need them?' … One of us needs to be the primary care provider, and the other one needs to be more of an adjuvant care provider."

Ultimately, the authors wrote, further research is needed "to understand how screening and follow-up care for veteran patients is best implemented into primary care settings."

The authors noted that future studies are needed to determine how their findings might apply to a broader range of health care professionals, as well as "to implement and evaluate innovative, efficient strategies for implementing assessment of military status into regular care processes."

One possible step the authors asked participants to comment on was adding veteran status as a demographic in electronic health records.

"Participants generally saw this to be useful and felt that it would help them remember to ask their patients about military service" and related questions, the authors wrote.

One interview subject, asked about such a screening tool, countered that it would only lengthen the visit.

But the prevalent tone of the interviews echoed the thoughts of another participant, who said, "It doesn't take much to just ask one more question."

Related AAFP News Coverage
Change Doubles Number of Vets Eligible for Care Outside VA
(3/25/2015)

More From AAFP
In the Trenches: Are Family Physicians an Answer to VA's Primary Care Crisis?
(7/15/2014)