BEHAVIORAL HEALTH CARE NEEDS AMONG AGING VETERANS IN RURAL OUTPATIENT CLINICS: PROVIDERS’ VIEWPOINTS

Aging Veterans frequently have cognitive and behavioral health problems in addition to physical health issues. Meeting these complex needs is challenging, particularly in rural areas with scarce resources. This project utilized an exploratory qualitative data collection method to better understand and address these needs. Focus groups (FG) of rural providers (N = 62) were conducted on site at eight VHA Community Based Outpatient Clinics (CBOCs) in three western states. Facilitators (2 per FG) used a semi-structured format with open-ended questions to prompt conversations among participants about patients’ complex behavioral health and physical health issues, family/caregiver concerns, clinic workflow, internal/external referrals, and desired services/resources. FG sessions were digitally recorded and transcribed verbatim with participant consent. Observation notes were also completed. Analysis began with an a priori set of coding categories (FG questions). We employed team coding to identify and refine codes and categories as new themes and patterns surfaced. Three major themes (with multiple subthemes) emerged from the discussions: challenges working with this population, caregiver issues, and interventions to improve care. Subthemes include provider burden, remoteness from urban medical center, difficulties coordinating specialty services, barriers to providing family and caregiver support; and difficulty navigating resource networks. Rural providers from VHA CBOCs in the western U.S. identified numerous challenges that complicate care for aging Veterans with co-morbid cognitive and behavioral health issues in rural settings and also offered practical suggestions to improve care. Findings are informing development of an evidence-informed intervention to improve access to specialty behavioral health care for these Veterans.