Improving care for rural veterans: are high dual users different?

BACKGROUND: Rural veterans face considerable barriers to access to care and are likely to seek health care services outside the Veterans Health Administration (VHA), or dual care.

OBJECTIVE: The objective of this study was to examine the characteristics of high users of dual care versus occasional and nonusers of dual care, and the determinants of satisfaction with care received by rural veterans.

DESIGN: The design was a cross-sectional observational study.

PARTICIPANTS: Structured telephone interviews of a random sample of veterans residing in rural Nebraska were conducted in 2011.

MAIN MEASURES: Veterans' frequency of use of dual care and satisfaction with care received were assessed using multinomial and ordinal regression models.

KEY RESULTS: Veterans who have an established relationship with a VHA provider or a personal doctor or nurse at the VHA and those who were more satisfied with VHA quality of care were less likely to be high users of dual care. Veterans who were Medicare beneficiaries, or had private insurance or chronic illnesses, or were confused about where to seek care were more likely to be users of dual care. Veterans who report being confused about where to seek care, and those who perceive lack of coordination between the VHA and non-VHA systems are less satisfied with care received.

CONCLUSIONS: Understanding what motivates veterans to use dual care and influences their satisfaction with care received will enable the VHA to implement policy that improves the quality of care provided to rural veterans.