“It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare
Background The 2014 Veterans Choice Act and subsequent 2018 Veteran’s Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of pa...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2024-03, Vol.39 (4), p.596-602 |
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| container_title | Journal of general internal medicine : JGIM |
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| creator | Ramalingam, NithyaPriya S. Barnes, Chrystal Patzel, Mary Kenzie, Erin S. Ono, Sarah S. Davis, Melinda M. |
| description | Background
The 2014 Veterans Choice Act and subsequent 2018 Veteran’s Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans.
Objective
To understand Veterans’ experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans.
Design
Qualitative descriptive design.
Participants
United States (US) Veterans in Northwestern states engaged in VA and/or community care.
Approach
Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis.
Key Results
We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women’s healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation.
Conclusions
Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans—especially those with medical complexities, those living far from healthcare services, or those seeking women’s healthcare. |
| doi_str_mv | 10.1007/s11606-023-08442-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2884675731</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2884675731</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-a942d977012e1fdfaff3b8822acac13a52ffefbd6cf710b58f6c10d9c44b4a9f3</originalsourceid><addsrcrecordid>eNp9kc9u1DAQhy0EotvCC3BAlrhwSRn_SZxwq6qWVloJVS0gTpbjjDcp2WRrO4g9VNrXQKIvt0-CyxaQOHDxHPzNN6P5EfKCwSEDUG8CYwUUGXCRQSklz9QjMmM5zzMmK_WYzKAsZVYqIffIfgjXAExwXj4le0JVIEHBjNxuNz_O43bzPdB59wXpaTc03bCgn8fJ009mTa9aP06LlsYW6dzUa98Nsd1u7t5SQy8m03fRxO4r0ss4NWs6OvoRI3ozhOSkJ99W6DscLAZ6ZNMb7t1naPrYWuPxGXniTB_w-UM9IB9OT66Oz7L5-3fnx0fzzApexMxUkjeVUsA4Mtc445yoy5JzY41lwuTcOXR1U1inGNR56QrLoKmslLU0lRMH5PXOu_LjzYQh6mUXLPa9GXCcgubpUIXKlWAJffUPep1OMaTttAAQIpeQV4niO8r6MQSPTq98tzR-rRno-3D0LhydwtG_wtEqNb18UE_1Eps_Lb_TSIDYASF9DQv0f2f_R_sTJiqe7w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3003354059</pqid></control><display><type>article</type><title>“It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Ramalingam, NithyaPriya S. ; Barnes, Chrystal ; Patzel, Mary ; Kenzie, Erin S. ; Ono, Sarah S. ; Davis, Melinda M.</creator><creatorcontrib>Ramalingam, NithyaPriya S. ; Barnes, Chrystal ; Patzel, Mary ; Kenzie, Erin S. ; Ono, Sarah S. ; Davis, Melinda M.</creatorcontrib><description>Background
The 2014 Veterans Choice Act and subsequent 2018 Veteran’s Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans.
Objective
To understand Veterans’ experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans.
Design
Qualitative descriptive design.
Participants
United States (US) Veterans in Northwestern states engaged in VA and/or community care.
Approach
Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis.
Key Results
We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women’s healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation.
Conclusions
Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans—especially those with medical complexities, those living far from healthcare services, or those seeking women’s healthcare.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-023-08442-7</identifier><identifier>PMID: 37904070</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Community health care ; Female ; Frustration ; Health care ; Health care access ; Health services ; Health Services Accessibility ; Humans ; Internal Medicine ; Legislation ; Medicine ; Medicine & Public Health ; Original Research: Qualitative Research ; Primary care ; Qualitative Research ; Rural areas ; Rural Population ; United States ; United States Department of Veterans Affairs ; Veterans</subject><ispartof>Journal of general internal medicine : JGIM, 2024-03, Vol.39 (4), p.596-602</ispartof><rights>The Author(s), under exclusive licence to Society of General Internal Medicine 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Society of General Internal Medicine.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-a942d977012e1fdfaff3b8822acac13a52ffefbd6cf710b58f6c10d9c44b4a9f3</cites><orcidid>0000-0002-9418-2495</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11606-023-08442-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11606-023-08442-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37904070$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ramalingam, NithyaPriya S.</creatorcontrib><creatorcontrib>Barnes, Chrystal</creatorcontrib><creatorcontrib>Patzel, Mary</creatorcontrib><creatorcontrib>Kenzie, Erin S.</creatorcontrib><creatorcontrib>Ono, Sarah S.</creatorcontrib><creatorcontrib>Davis, Melinda M.</creatorcontrib><title>“It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
The 2014 Veterans Choice Act and subsequent 2018 Veteran’s Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans.
Objective
To understand Veterans’ experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans.
Design
Qualitative descriptive design.
Participants
United States (US) Veterans in Northwestern states engaged in VA and/or community care.
Approach
Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis.
Key Results
We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women’s healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation.
Conclusions
Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans—especially those with medical complexities, those living far from healthcare services, or those seeking women’s healthcare.</description><subject>Community health care</subject><subject>Female</subject><subject>Frustration</subject><subject>Health care</subject><subject>Health care access</subject><subject>Health services</subject><subject>Health Services Accessibility</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Legislation</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research: Qualitative Research</subject><subject>Primary care</subject><subject>Qualitative Research</subject><subject>Rural areas</subject><subject>Rural Population</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQhy0EotvCC3BAlrhwSRn_SZxwq6qWVloJVS0gTpbjjDcp2WRrO4g9VNrXQKIvt0-CyxaQOHDxHPzNN6P5EfKCwSEDUG8CYwUUGXCRQSklz9QjMmM5zzMmK_WYzKAsZVYqIffIfgjXAExwXj4le0JVIEHBjNxuNz_O43bzPdB59wXpaTc03bCgn8fJ009mTa9aP06LlsYW6dzUa98Nsd1u7t5SQy8m03fRxO4r0ss4NWs6OvoRI3ozhOSkJ99W6DscLAZ6ZNMb7t1naPrYWuPxGXniTB_w-UM9IB9OT66Oz7L5-3fnx0fzzApexMxUkjeVUsA4Mtc445yoy5JzY41lwuTcOXR1U1inGNR56QrLoKmslLU0lRMH5PXOu_LjzYQh6mUXLPa9GXCcgubpUIXKlWAJffUPep1OMaTttAAQIpeQV4niO8r6MQSPTq98tzR-rRno-3D0LhydwtG_wtEqNb18UE_1Eps_Lb_TSIDYASF9DQv0f2f_R_sTJiqe7w</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Ramalingam, NithyaPriya S.</creator><creator>Barnes, Chrystal</creator><creator>Patzel, Mary</creator><creator>Kenzie, Erin S.</creator><creator>Ono, Sarah S.</creator><creator>Davis, Melinda M.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9418-2495</orcidid></search><sort><creationdate>20240301</creationdate><title>“It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare</title><author>Ramalingam, NithyaPriya S. ; Barnes, Chrystal ; Patzel, Mary ; Kenzie, Erin S. ; Ono, Sarah S. ; Davis, Melinda M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-a942d977012e1fdfaff3b8822acac13a52ffefbd6cf710b58f6c10d9c44b4a9f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Community health care</topic><topic>Female</topic><topic>Frustration</topic><topic>Health care</topic><topic>Health care access</topic><topic>Health services</topic><topic>Health Services Accessibility</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Legislation</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research: Qualitative Research</topic><topic>Primary care</topic><topic>Qualitative Research</topic><topic>Rural areas</topic><topic>Rural Population</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ramalingam, NithyaPriya S.</creatorcontrib><creatorcontrib>Barnes, Chrystal</creatorcontrib><creatorcontrib>Patzel, Mary</creatorcontrib><creatorcontrib>Kenzie, Erin S.</creatorcontrib><creatorcontrib>Ono, Sarah S.</creatorcontrib><creatorcontrib>Davis, Melinda M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ramalingam, NithyaPriya S.</au><au>Barnes, Chrystal</au><au>Patzel, Mary</au><au>Kenzie, Erin S.</au><au>Ono, Sarah S.</au><au>Davis, Melinda M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>“It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>39</volume><issue>4</issue><spage>596</spage><epage>602</epage><pages>596-602</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
The 2014 Veterans Choice Act and subsequent 2018 Veteran’s Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans.
Objective
To understand Veterans’ experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans.
Design
Qualitative descriptive design.
Participants
United States (US) Veterans in Northwestern states engaged in VA and/or community care.
Approach
Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis.
Key Results
We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women’s healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation.
Conclusions
Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans—especially those with medical complexities, those living far from healthcare services, or those seeking women’s healthcare.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>37904070</pmid><doi>10.1007/s11606-023-08442-7</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9418-2495</orcidid></addata></record> |
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| ispartof | Journal of general internal medicine : JGIM, 2024-03, Vol.39 (4), p.596-602 |
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| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Community health care Female Frustration Health care Health care access Health services Health Services Accessibility Humans Internal Medicine Legislation Medicine Medicine & Public Health Original Research: Qualitative Research Primary care Qualitative Research Rural areas Rural Population United States United States Department of Veterans Affairs Veterans |
| title | “It’s Like Finding Your Way Through the Labyrinth”: a Qualitative Study of Veterans’ Experiences Accessing Healthcare |
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