Original Research

A Qualitative Study of Treating Dual-Use Patients Across Health Care Systems

Fed Pract. 2015 August;32(8):32-37

References

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As demonstrated by recent events, there are still VHA health care access issues for veterans. Recently, VA leadership and the U.S. Congress proposed that veterans have greater access to community providers as well as VHA in order to overcome delays in care.¹⁹ As this option is explored and put into practice, it is more important than ever to consider the need for care coordination and management of dual-use patients, to ensure good communication and care that is timely, safe, and high quality.

Few models exist in which 2 PCPs coordinate across health care systems, and greater understanding of this dual use is needed. This information is important in designing interventions to improve care coordination across systems to ensure continuity of care, patient safety, and patient satisfaction. Although some work has been done to examine the perspectives of non-VA PCPs, little is known about VHA provider perspectives on rural veteran dual use.^17,18 This study explores VHA provider perspectives and identifies areas where interventions to improve care coordination across systems might be targeted.

Next steps for intervention studies would be to improve communication and develop educational tools to aid in the coordination of care between VHA and non-VHA providers. A recent example of this is the Co-Management Toolkit developed by the Veterans Rural Health Resource Center-Central Region, which provides information on VHA policies and targets non-VHA providers.²⁰ Although VHA perceptions of comanageing dual-use patients were the target, a similar study of non-VHA providers is important to understand this complex and multifaceted dynamic. Additional work is needed to measure the impact of dual use on clinical outcomes, patient safety and quality, and efficient use of resources, as these are understudied. As dual use continues and potentially increases with the ACA and changing health care in the U.S., it is important to understand the management of patients using multiple health care systems. This is salient as primary care adopts the PACT model and to inform interventions to improve quality and safety while eliminating duplicative health care and costs.

Acknowledgements
The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region (VRHRC-CR) and the VA Health Services Research and Development (HSR&D) Service, the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Health Care System, and Center to Improve Veteran Involvement in Care (CIVIC) at VA Portland Health Care System. Dr. Reisinger was supported by a Research Career Development Award from the Health Services Research and Development Service, Department of Veterans Affairs (CD1 08-013-1).

We would like to thank all health care providers who graciously agreed to participate in this study and VRHRC-CR staff, in particular Monica Paez for assistance on this manuscript.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
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