A descriptive analysis of medical health services utilization of Veterans living in Ontario: a retrospective cohort study using administrative healthcare data

Abstract

Background: Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system.

Methods: This is a retrospective cohort study designed to use Ontario's provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release.

Results: The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1-83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0-61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2-41.5) went to the emergency department in that same time period and 9.9 % (9.5-10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity.

Conclusion: This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.

Keywords: Administrative healthcare data; Health services; Military personnel; Veterans.

Fig. 1

Description of cohort eligibility and exclusion criteria

Fig. 2

The proportion of Veterans in Ontario accessing a family physician, specialist, the emergency department and requiring hospitalization for non-mental health purposes in the twenty years following entry into the Ontario healthcare system

Fig. 3

a The proportion of Veterans in Ontario visiting a family doctor for non-mental health reasons, stratified by age of the Veteran at entry into the Ontario healthcare system. b The average number of non-mental health family doctor visits by Veterans in Ontario who saw a family doctor, stratified by age of the Veteran at entry into the Ontario healthcare system. * The average was calculated for Veterans using this service at least once over the time interval

Fig. 4

a The proportion of Veterans in Ontario visiting a specialist physician for non-mental health reasons, stratified by age of the Veteran at entry into the Ontario healthcare system. b The average number of non-mental health specialist physician visits by Veterans in Ontario who saw a specialist physician, stratified by age of the Veteran at entry into the Ontario healthcare syste. * The average was calculated for Veterans using this service at least once over the time interval

Fig. 5

a The proportion of Veterans in Ontario accessing the emergency department for non-mental health reasons, stratified by age of the Veteran at entry into the Ontario healthcare system. b The average number of emergency department visits for non-mental health reasons by Veterans in Ontario, stratified by age of the Veteran at entry into the provincial healthcare system. * The average was calculated for Veterans using this service at least once over the time interval