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. 1999 May;14(5):274-80.
doi: 10.1046/j.1525-1497.1999.00335.x.

Dual use of VA and non-VA primary care

S J Borowsky  1 , D C Cowper
Affiliations

Dual use of VA and non-VA primary care

S J Borowsky et al. J Gen Intern Med. 1999 May.

Abstract

Objective: To determine how frequently veterans use non-Department of Veterans Affairs (VA) sources of care in addition to primary care provided by the VA and to assess the association of this pattern of "dual use" to patient characteristics and satisfaction with VA care.

Design: Cross-sectional telephone survey of randomly selected patients from four VA medical centers.

Participants: Of 1,240 eligible veterans, 830 (67%) participated in the survey.

Measurements and main results: Survey data were used to assess whether a veteran reported receiving primary care from both VA and non-VA sources of care, as well as the proportion of all primary care visits made to non-VA providers. Of 577 veterans who reported VA primary care visits, 159 (28%) also reported non-VA primary care visits. Among these dual users the mean proportion of non-VA primary care visits was 0.50. Multivariate analysis revealed that the odds of dual use were reduced for those without insurance (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.18, 0.66) and with less education (OR 0.60; 95% CI 0.38, 0.92), while increased for those not satisfied with VA care (OR 2.40; 95% CI 1.40, 4.13). Among primary care dual users, the proportion of primary care visits made to non-VA providers was decreased for patients with heart disease ( p <.05) and patients with alcohol or drug dependence ( p <.05).

Conclusions: Primary care dual use was common among these veterans. Those with more education, those with any type of insurance, and those not satisfied with VA care were more likely to be dual users. Non-VA care accounted for approximately half of dual users' total primary care visits.

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Comment in

  • Does the VA provide "primary" primary care?
    Petersen LA, Wright S. Petersen LA, et al. J Gen Intern Med. 1999 May;14(5):318-9. doi: 10.1046/j.1525-1497.1999.00343.x. J Gen Intern Med. 1999. PMID: 10337043 Free PMC article. Review. No abstract available.
  • Orientation clinics.
    Nardone DA. Nardone DA. J Gen Intern Med. 2001 May;16(5):349. doi: 10.1046/j.1525-1497.2001.10219-4.x. J Gen Intern Med. 2001. PMID: 11405198 Free PMC article. No abstract available.

References

    1. Vision for Change: A Plan to Restructure the Veterans Health Administration, Washington, DC: VA Undersecretary for Health; February 1995.
    1. Starfield B. Primary Care: Concept, Evaluation, and Policy. New York, NY: Oxford University Press; 1992.
    1. Fisher ES, Welch HG. The future of the Department of Veterans Affairs health care system. JAMA. 1995;273:651–5. - PubMed
    1. Fisher ES. VA Outcomes Group 1994 Report. Unmanaged Care: Dual Utilization of the Veterans Health Administration and Medicare Health Care Systems. White River Junction, Vt: Veterans Affairs Medical Center; 1994.
    1. Fleming C, Fisher ES, Chang C, Bubolz TA, Malenka DJ. Studying outcomes and hospital utilization in the elderly: the advantages of a merged data base for Medicare and Veterans Affairs hospitals. Med Care. 1992;30:377–91. - PubMed

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