Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Dec 1:13:498.
doi: 10.1186/1472-6963-13-498.

Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

Christine A Elnitsky  1 , Elena M Andresen, Michael E Clark, Suzanne McGarity, Carmen G Hall, Robert D Kerns
Affiliations

Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

Christine A Elnitsky et al. BMC Health Serv Res. .

Abstract

Background: The U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans.

Methods: We studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care.

Results: Nearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees' odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee's odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care.

Conclusions: This study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to receiving services exclusively from the VA, including mutable health delivery system factors.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Model of VA service utilization.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Afghanistan and Iraq, mental health problems, and barriers to care. N Engl J Med. 2004;13(1):13–22. doi: 10.1056/NEJMoa040603. - DOI - PubMed
    1. Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Afghanistan and Iraq veterans using department of veterans affairs health care, 2002–2008. Am J Public Health. 2009;13(9):1651–1658. doi: 10.2105/AJPH.2008.150284. - DOI - PMC - PubMed
    1. Haskell SG, Brandt CA, Krebs EE, Skanderson M, Kerns RD, Goulet JL. Pain among veterans of operations enduring freedom and Iraqi freedom: do women and men differ? Pain Med. 2009;13(7):1167–73. doi: 10.1111/j.1526-4637.2009.00714.x. - DOI - PubMed
    1. Gironda RJ, Clark ME, Massengale JP, Walker RL. Pain among veterans of operations enduring freedom and Iraqi freedom. Pain Med. 2006;13(4):339–43. doi: 10.1111/j.1526-4637.2006.00146.x. - DOI - PubMed
    1. Clark ME. Pain, Psychiatric Disorders, and Disability among Veterans With and Without Polytrauma. Tampa, FL: James A. Haley Veterans Hospital; 2007. (Unpublished Final Report to VA Health Services Research and Development Service., project number SDR −7-047).

Publication types

MeSH terms

LinkOut - more resources