title: Dual use of VA and non-VA primary care.
abstract: OBJECTIVE
  To determine how frequently veterans use non-Department of Veterans Affairs (VA) sources of care in addition to primary care provided by the VA and to assess the association of this pattern of "dual use" to patient characteristics and satisfaction with VA care.
  
  
  METHODS
  Cross-sectional telephone survey of randomly selected patients from four VA medical centers.
  
  
  METHODS
  Of 1,240 eligible veterans, 830 (67%) participated in the survey.
  
  
  RESULTS
  Survey data were used to assess whether a veteran reported receiving primary care from both VA and non-VA sources of care, as well as the proportion of all primary care visits made to non-VA providers. Of 577 veterans who reported VA primary care visits, 159 (28%) also reported non-VA primary care visits. Among these dual users the mean proportion of non-VA primary care visits was 0.50. Multivariate analysis revealed that the odds of dual use were reduced for those without insurance (odds ratio [OR] 0.34; 95% confidence interval [CI] 0.18, 0.66) and with less education (OR 0.60; 95% CI 0.38, 0.92), while increased for those not satisfied with VA care (OR 2.40; 95% CI 1.40, 4.13). Among primary care dual users, the proportion of primary care visits made to non-VA providers was decreased for patients with heart disease ( p <.05) and patients with alcohol or drug dependence ( p <.05).
  
  
  CONCLUSIONS
  Primary care dual use was common among these veterans. Those with more education, those with any type of insurance, and those not satisfied with VA care were more likely to be dual users. Non-VA care accounted for approximately half of dual users' total primary care visits.
authors.affiliation: VAMC Center for Chronic Disease Outcomes Research, Minneapolis, MN, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Borowsky
authors.forename: D C
authors.initials: DC
authors.lastname: Cowper
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012494:Sampling Studies; D013023:South Dakota; D014600:Utilization Review / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*