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Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans

BACKGROUND: The 2019 VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or MISSION Act, aimed to improve rural veteran access to care by expanding coverage for services in the community. Increased access to clinicians outside the US Department of Veterans Affairs (VA) could be...

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Autores principales: Patzel, Mary, Barnes, Chrystal, Ramalingam, NithyaPriya, Gunn, Rose, Kenzie, Erin S., Ono, Sarah S., Davis, Melinda M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356713/
https://www.ncbi.nlm.nih.gov/pubmed/37340259
http://dx.doi.org/10.1007/s11606-023-08126-2
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author Patzel, Mary
Barnes, Chrystal
Ramalingam, NithyaPriya
Gunn, Rose
Kenzie, Erin S.
Ono, Sarah S.
Davis, Melinda M.
author_facet Patzel, Mary
Barnes, Chrystal
Ramalingam, NithyaPriya
Gunn, Rose
Kenzie, Erin S.
Ono, Sarah S.
Davis, Melinda M.
author_sort Patzel, Mary
collection PubMed
description BACKGROUND: The 2019 VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or MISSION Act, aimed to improve rural veteran access to care by expanding coverage for services in the community. Increased access to clinicians outside the US Department of Veterans Affairs (VA) could benefit rural veterans, who often face obstacles obtaining VA care. This solution, however, relies on clinics willing to navigate VA administrative processes. OBJECTIVE: To investigate the experiences rural, non-VA clinicians and staff have while providing care to rural veterans and inform challenges and opportunities for high-quality, equitable care access and delivery. DESIGN: Phenomenological qualitative study. PARTICIPANTS: Non-VA-affiliated primary care clinicians and staff in the Pacific Northwest. APPROACH: Semi-structured interviews with a purposive sample of eligible clinicians and staff between May and August 2020; data analyzed using thematic analysis. KEY RESULTS: We interviewed 13 clinicians and staff and identified four themes and multiple challenges related to providing care for rural veterans: (1) Confusion, variability and delays for VA administrative processes, (2) clarifying responsibility for dual-user veteran care, (3) accessing and sharing medical records outside the VA, and (4) negotiating communication pathways between systems and clinicians. Informants reported using workarounds to combat challenges, including using trial and error to gain expertise in VA system navigation, relying on veterans to act as intermediaries to coordinate their care, and depending on individual VA employees to support provider-to-provider communication and share system knowledge. Informants expressed concerns that dual-user veterans were more likely to have duplication or gaps in services. CONCLUSIONS: Findings highlight the need to reduce the bureaucratic burden of interacting with the VA. Further work is needed to tailor structures to address challenges rural community providers experience and to identify strategies to reduce care fragmentation across VA and non-VA providers and encourage long-term commitment to care for veterans.
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spelling pubmed-103567132023-07-21 Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans Patzel, Mary Barnes, Chrystal Ramalingam, NithyaPriya Gunn, Rose Kenzie, Erin S. Ono, Sarah S. Davis, Melinda M. J Gen Intern Med Original Research: Qualitative Research BACKGROUND: The 2019 VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or MISSION Act, aimed to improve rural veteran access to care by expanding coverage for services in the community. Increased access to clinicians outside the US Department of Veterans Affairs (VA) could benefit rural veterans, who often face obstacles obtaining VA care. This solution, however, relies on clinics willing to navigate VA administrative processes. OBJECTIVE: To investigate the experiences rural, non-VA clinicians and staff have while providing care to rural veterans and inform challenges and opportunities for high-quality, equitable care access and delivery. DESIGN: Phenomenological qualitative study. PARTICIPANTS: Non-VA-affiliated primary care clinicians and staff in the Pacific Northwest. APPROACH: Semi-structured interviews with a purposive sample of eligible clinicians and staff between May and August 2020; data analyzed using thematic analysis. KEY RESULTS: We interviewed 13 clinicians and staff and identified four themes and multiple challenges related to providing care for rural veterans: (1) Confusion, variability and delays for VA administrative processes, (2) clarifying responsibility for dual-user veteran care, (3) accessing and sharing medical records outside the VA, and (4) negotiating communication pathways between systems and clinicians. Informants reported using workarounds to combat challenges, including using trial and error to gain expertise in VA system navigation, relying on veterans to act as intermediaries to coordinate their care, and depending on individual VA employees to support provider-to-provider communication and share system knowledge. Informants expressed concerns that dual-user veterans were more likely to have duplication or gaps in services. CONCLUSIONS: Findings highlight the need to reduce the bureaucratic burden of interacting with the VA. Further work is needed to tailor structures to address challenges rural community providers experience and to identify strategies to reduce care fragmentation across VA and non-VA providers and encourage long-term commitment to care for veterans. Springer International Publishing 2023-06-20 2023-07 /pmc/articles/PMC10356713/ /pubmed/37340259 http://dx.doi.org/10.1007/s11606-023-08126-2 Text en © The author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Research: Qualitative Research
Patzel, Mary
Barnes, Chrystal
Ramalingam, NithyaPriya
Gunn, Rose
Kenzie, Erin S.
Ono, Sarah S.
Davis, Melinda M.
Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
title Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
title_full Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
title_fullStr Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
title_full_unstemmed Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
title_short Jumping Through Hoops: Community Care Clinician and Staff Experiences Providing Primary Care to Rural Veterans
title_sort jumping through hoops: community care clinician and staff experiences providing primary care to rural veterans
topic Original Research: Qualitative Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356713/
https://www.ncbi.nlm.nih.gov/pubmed/37340259
http://dx.doi.org/10.1007/s11606-023-08126-2
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