Ambulatory Care Coordination Issues With Dual Use Veteran Organ Transplant Recipients

Abstract

The previous literature indicates that patients receiving ongoing care in both Veterans Affairs (VA) and non-VA setting (dual care) may have reduced health outcomes. The objective of this study was to assess the impact of dual care provided to a veteran solid organ transplant population. This was a retrospective cohort study of stable solid organ transplant recipients receiving care at both a Veterans Affairs Medical Center and transplant center. Forty-six veteran organ transplant recipients met inclusion criteria. At baseline, mean age at transplant was 57 ± 10 years; 93% were male, 61% received kidney transplants. Thirty-nine percent of patients did not receive immunosuppressant concentrations at the recommended intervals. The incidence of veterans that had at least 2 providers caring for the same comorbidity was 63% for hypertension, 58% for diabetes, and 27% for dyslipidemia. Approximately one-third of veterans had documentation of care provided by the other institutions (30%-37%), and 93% of patients had medication regimen discrepancies between health-care systems, with 52% of patients having at least 1 medication discrepancy involving an immunosuppressant. Most veteran solid organ transplant recipients receive care across multiple health-care systems, with significant care coordination issues leading to gaps and duplications in their management. Improved communication between health systems is imperative to optimize outcomes in dual use veterans such as organ transplant recipients.

Keywords: ambulatory care; medication safety; transitions of care.