Veterans' use of and satisfaction with dual care: Perspectives of rural veterans in Nebraska

The purpose of this study is to develop an in-depth understanding of the barriers and enablers of effective dual care (care received within and outside the VA health system) for rural veterans. The study also examines the perceptions of rural veterans on the effectiveness of the current system of dual care in terms of satisfaction, access, and coordination of care, and the determinants of provider choice for primary and specialty care of rural veterans. The conceptual framework for this study is based on Anderson's health seeking behavior model (Anderson, 1995). The dependent variables are: use of dual care and satisfaction with care received. The key independent variables are: Predisposing: Age, gender, race, education; Need: Co-morbidities, disability status; and Enabling: Distance to provider, VA priority status, type of insurance, VA entitlement, perceived quality of care, and cost of care. Telephone interviews of a random sample of rural veterans in Nebraska are being conducted, to examine their determinants of choice of health care provider for primary and specialty care and their perspectives on the current model of dual care for veterans. A random sample of rural veterans was obtained from the database used for the CDC BRFSS interviews. From this sampling frame, a random sample of rural veterans in Nebraska was obtained and 1,000 telephone interviews of veterans residing in rural Nebraska will be completed. The telephone interviews are ongoing and are expected to be completed on March 1, 2011. The analysis of results will be completed by June 30, 2011. The information obtained from the interviews will help VA policy makers design an effective shared care system for rural veterans. The characteristics of such a system would be such that veterans would receive care both within their communities and at the VA health care centers.