title: Improving care for rural veterans: are high dual users different?
abstract: 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.
  
  
  METHODS
  The design was a cross-sectional observational study.
  
  
  METHODS
  Structured telephone interviews of a random sample of veterans residing in rural Nebraska were conducted in 2011.
  
  
  METHODS
  Veterans' frequency of use of dual care and satisfaction with care received were assessed using multinomial and ordinal regression models.
  
  
  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.
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Preethy
authors.initials: P
authors.lastname: Nayar
authors.forename: Fang
authors.initials: F
authors.lastname: Yu
authors.forename: Bettye
authors.initials: B
authors.lastname: Apenteng
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D006278:Medicare; D017060:Patient Satisfaction; D012424:Rural Population; D014481:United States; D014728:Veterans
keywords: access to care; dual care; rural veterans; satisfaction with care; telephone interviews