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A Qualitative Study of Primary Care Providers' Experiences with the Veterans Choice Program.
J Gen Intern Med. 2019 04; 34(4):598-603.JG

Abstract

BACKGROUND

The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with referrals are not well understood.

OBJECTIVE

To understand VA PCPs' experiences referring patients to community specialists while VA works to expand and refine the implementation of the Choice Program.

DESIGN

Qualitative study using interview methods.

PARTICIPANTS

Semi-structured telephone interviews were conducted with VA primary care providers (N = 72 out of 599 contacted) recruited nationally.

APPROACH

Open-ended interview questions elicited PCP perceptions and experiences with referrals to community specialists via the Choice Program. Keywords were identified using automated coding features in ATLAS.ti and evaluated using conventional content analysis to inductively describe the qualitative data.

KEY RESULTS

VA PCPs emphasized problems with care coordination and continuity between the VA and community specialists (e.g., "It is extremely difficult for us to obtain and continue continuity of care because there's not much communication with the community specialist"). They described difficulties with tracking the initial referral, coordinating care after receiving community specialty care, accessing community medical records, and aligning community specialists' prescriptions with the VA formulary.

CONCLUSIONS

The VA Choice Program provides access to community specialists for VA patients; however, VA primary care providers face challenges tracking referrals to community specialists and in coordinating care. Strategies to improve care coordination between the VA and community providers should focus on providing PCPs with information to follow Veterans throughout the Choice referral process and follow-up.

Links

PMC Free PDF

Authors+Show Affiliations

Nevedal AL
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. Andrea.Nevedal@va.gov.
Wagner TH
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Menlo Park, CA, USA. Department of Surgery, Stanford University, Stanford, CA, USA.
Ellerbe LS
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.
Asch SM
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA.
Koenig CJ
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA. Department of Communication Studies, San Francisco State University, San Francisco, CA, USA.

MeSH

Attitude of Health PersonnelCommunity Health ServicesContinuity of Patient CareFemaleHealth Services AccessibilityHumansMaleQualitative ResearchReferral and ConsultationUnited StatesUnited States Department of Veterans AffairsVeterans Health

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

30684200

Citation

Nevedal, Andrea L., et al. "A Qualitative Study of Primary Care Providers' Experiences With the Veterans Choice Program." Journal of General Internal Medicine, vol. 34, no. 4, 2019, pp. 598-603.
Nevedal AL, Wagner TH, Ellerbe LS, et al. A Qualitative Study of Primary Care Providers' Experiences with the Veterans Choice Program. J Gen Intern Med. 2019;34(4):598-603.
Nevedal, A. L., Wagner, T. H., Ellerbe, L. S., Asch, S. M., & Koenig, C. J. (2019). A Qualitative Study of Primary Care Providers' Experiences with the Veterans Choice Program. Journal of General Internal Medicine, 34(4), 598-603. https://doi.org/10.1007/s11606-018-4810-2
Nevedal AL, et al. A Qualitative Study of Primary Care Providers' Experiences With the Veterans Choice Program. J Gen Intern Med. 2019;34(4):598-603. PubMed PMID: 30684200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Qualitative Study of Primary Care Providers' Experiences with the Veterans Choice Program. AU - Nevedal,Andrea L, AU - Wagner,Todd H, AU - Ellerbe,Laura S, AU - Asch,Steven M, AU - Koenig,Christopher J, Y1 - 2019/01/25/ PY - 2018/02/16/received PY - 2018/11/14/accepted PY - 2018/07/02/revised PY - 2019/1/27/pubmed PY - 2020/9/9/medline PY - 2019/1/27/entrez KW - Veterans KW - implementation research KW - primary care KW - qualitative research KW - referrals KW - specialty care SP - 598 EP - 603 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 34 IS - 4 N2 - BACKGROUND: The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with referrals are not well understood. OBJECTIVE: To understand VA PCPs' experiences referring patients to community specialists while VA works to expand and refine the implementation of the Choice Program. DESIGN: Qualitative study using interview methods. PARTICIPANTS: Semi-structured telephone interviews were conducted with VA primary care providers (N = 72 out of 599 contacted) recruited nationally. APPROACH: Open-ended interview questions elicited PCP perceptions and experiences with referrals to community specialists via the Choice Program. Keywords were identified using automated coding features in ATLAS.ti and evaluated using conventional content analysis to inductively describe the qualitative data. KEY RESULTS: VA PCPs emphasized problems with care coordination and continuity between the VA and community specialists (e.g., "It is extremely difficult for us to obtain and continue continuity of care because there's not much communication with the community specialist"). They described difficulties with tracking the initial referral, coordinating care after receiving community specialty care, accessing community medical records, and aligning community specialists' prescriptions with the VA formulary. CONCLUSIONS: The VA Choice Program provides access to community specialists for VA patients; however, VA primary care providers face challenges tracking referrals to community specialists and in coordinating care. Strategies to improve care coordination between the VA and community providers should focus on providing PCPs with information to follow Veterans throughout the Choice referral process and follow-up. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/30684200/A_Qualitative_Study_of_Primary_Care_Providers'_Experiences_with_the_Veterans_Choice_Program_ DB - PRIME DP - Unbound Medicine ER -