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. 2021 Mar-Apr;34(2):291-300.
doi: 10.3122/jabfm.2021.02.200332.

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment

Matthew R Augustine  1 , Tanieka Mason  2 , Abigail Baim-Lance  2 , Kenneth Boockvar  2
Affiliations

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment

Matthew R Augustine et al. J Am Board Fam Med. 2021 Mar-Apr.

Abstract

Background: Older veterans in urban settings rely less on the Veterans Health Administration (VHA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VHA and non-VHA use across the health status of older, urban-dwelling veterans.

Methods: We examined open-ended responses from 177 veterans who were enrolled in primary care at the Bronx VA Medical Center, used non-VHA care in prior 2 years, and completed baseline interviews in a care coordination trial from March 2016 to August 2017. Using content analysis, we coded and categorized key terms and concepts into an established access framework. This framework included 5 categories: acceptability (relationship, second opinion), accessibility (distance, travel); affordability; availability (supply, specialty care); and accommodation (organization, wait-time). Self-reported health status was stratified by excellent/very good, good, and fair/poor.

Results: We were able to categorize the responses of 166 veterans, who were older (≥75 years, 61%), minority race and ethnicity (77%), and low income (<$25,000/y, 51%). Veterans mentioned acceptability (42%) and accessibility (37%) the most, followed by affordability (33%), availability (25%), and accommodation (11%). With worse self-reported health status, accessibility intensified (excellent/very good, 24%; fair/poor, 46%; P = .031) particularly among minority veterans, while acceptability remained prominent (excellent/very good, 49%; fair/poor, 37%; P = .25). Other categories were mentioned less with no significant difference across health status.

Conclusions: Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VHA population.

Keywords: Access to Health Care; Aging, Geriatrics; Health Status; Military Medicine; Primary Health Care; Qualitative Research; Urban Population; Veterans Health Administration.

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Conflict of interest statement

Conflict of interest: All authors report none.

Figures

Figure:
Figure:. Percentage of patients mentioning the categories of Acceptability, Accessibility, Affordability, Availability and Accommodation as reasons for using VA and non-VA services across self-reported health status.
Self-reported health status categorized as excellent/very good (black bars), good (gray bars), and fair/poor (white bars). *p<0.05
See this image and copyright information in PMC

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