Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis

Pascale Schwab, Harlan Sayles, Debra Bergman, Grant W. Cannon, Kaleb Michaud, Ted R. Mikuls, Jennifer Barton

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Many veterans enrolled in Veterans Affairs (VA) health care systems also receive care through other health care systems. Both VA and non-VA health care use must therefore be considered when conducting research in this population. This study characterized dual-care utilization in veterans with rheumatoid arthritis (RA) and explored associations with RA disease activity. Methods: Through a questionnaire mailed to RA patients at 3 VA sites, veterans reported medical services by non-VA primary care and subspecialty providers, comorbidities, non-VA medications, and hospitalizations. Disease Activity Score in 28 joints (DAS28) and Multidimensional Health Assessment Questionnaire (MD-HAQ) scores were recorded during VA clinic visits, and respondent groups were compared. Results: Of the 510 participants surveyed, 318 (62%) responded. Respondents were older (ages 69 versus 66 years; P = 0.006), more likely nonsmokers (80% versus 67%; P = 0.001), and had lower disease activity (DAS28 3.3 versus 3.8; P < 0.001, MD-HAQ 0.8 versus 0.9; P = 0.01) than nonrespondents (n = 192 [38%]). The respondents with a non-VA provider (n = 130 [41%]) were older (71 versus 68 years; P = 0.001) and had more education (14 versus 13 years; P = 0.021) than nondual-care users. Only 6% of respondents reported having a non-VA rheumatologist, with 2% receiving a non-VA prescribed biologic agent or disease-modifying antirheumatic drug. Conclusion: In this study, VA beneficiaries with RA had lower dual-care utilization than previously reported for the general VA population, with few patients receiving dual rheumatology care or non-VA RA medications. This survey suggests that most US veterans with RA who access VA care use the VA as their primary source of arthritis care.

Original languageEnglish (US)
Pages (from-to)776-782
Number of pages7
JournalArthritis Care and Research
Volume69
Issue number6
DOIs
StatePublished - Jun 1 2017

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Veterans Health
Veterans
Rheumatoid Arthritis
Delivery of Health Care
Joints
Surveys and Questionnaires
Antirheumatic Agents
Health
Biological Factors
Rheumatology
Ambulatory Care
Population
Arthritis
Comorbidity
Primary Health Care
Hospitalization

ASJC Scopus subject areas

  • Rheumatology

Cite this

Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis. / Schwab, Pascale; Sayles, Harlan; Bergman, Debra; Cannon, Grant W.; Michaud, Kaleb; Mikuls, Ted R.; Barton, Jennifer.

In: Arthritis Care and Research, Vol. 69, No. 6, 01.06.2017, p. 776-782.

Research output: Contribution to journalArticle

Schwab, Pascale ; Sayles, Harlan ; Bergman, Debra ; Cannon, Grant W. ; Michaud, Kaleb ; Mikuls, Ted R. ; Barton, Jennifer. / Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis. In: Arthritis Care and Research. 2017 ; Vol. 69, No. 6. pp. 776-782.
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abstract = "Objective: Many veterans enrolled in Veterans Affairs (VA) health care systems also receive care through other health care systems. Both VA and non-VA health care use must therefore be considered when conducting research in this population. This study characterized dual-care utilization in veterans with rheumatoid arthritis (RA) and explored associations with RA disease activity. Methods: Through a questionnaire mailed to RA patients at 3 VA sites, veterans reported medical services by non-VA primary care and subspecialty providers, comorbidities, non-VA medications, and hospitalizations. Disease Activity Score in 28 joints (DAS28) and Multidimensional Health Assessment Questionnaire (MD-HAQ) scores were recorded during VA clinic visits, and respondent groups were compared. Results: Of the 510 participants surveyed, 318 (62{\%}) responded. Respondents were older (ages 69 versus 66 years; P = 0.006), more likely nonsmokers (80{\%} versus 67{\%}; P = 0.001), and had lower disease activity (DAS28 3.3 versus 3.8; P < 0.001, MD-HAQ 0.8 versus 0.9; P = 0.01) than nonrespondents (n = 192 [38{\%}]). The respondents with a non-VA provider (n = 130 [41{\%}]) were older (71 versus 68 years; P = 0.001) and had more education (14 versus 13 years; P = 0.021) than nondual-care users. Only 6{\%} of respondents reported having a non-VA rheumatologist, with 2{\%} receiving a non-VA prescribed biologic agent or disease-modifying antirheumatic drug. Conclusion: In this study, VA beneficiaries with RA had lower dual-care utilization than previously reported for the general VA population, with few patients receiving dual rheumatology care or non-VA RA medications. This survey suggests that most US veterans with RA who access VA care use the VA as their primary source of arthritis care.",
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