Non-VA primary care providers' perspectives on comanagement for rural veterans.
BACKGROUND
Many veterans utilize health care services within and outside of the Department of Veterans Affairs (VA). There are limited VA care coordination resources for non-VA primary care providers (PCPs), and the non-VA provider perspective on caring for veterans is underrepresented. The VA requires Patient Aligned Care Teams to coordinate care for veterans across health systems.


OBJECTIVE
To elicit perspectives of PCPs on caring for veterans who use both VA and non-VA health care.


METHODS
Qualitative data from semistructured telephone interviews were interpreted in the context of quantitative survey results. Participants were PCPs in a practice-based research network in 2011. 67 non-VA PCPs completed surveys, and descriptive statistics were performed. 21 semistructured telephone interviews were transcribed and underwent thematic analysis.


RESULTS
Current communication with VA was viewed as poor, and many believed this led to poor patient outcomes. The veteran was identified as the main vehicle for information transfer between providers, which was viewed as undesirable. Non-VA providers felt they were interacting with VA as a system rather than with individual providers.


CONCLUSIONS
VA system barriers hinder communication between providers, possibly resulting in fragmented care. Addressing these barriers will potentially improve patient safety and satisfaction.
Department of Family Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242.
Anne
A
Gaglioti
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, IA 52246.
Ashley
A
Cozad
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, IA 52246.
Stacy
S
Wittrock
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, IA 52246.
Kenda
K
Stewart
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, IA 52246.
Michelle
M
Lampman
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, IA 52246.
Sarah
S
Ono
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, IA 52246.
Heather Schacht
HS
Reisinger
VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, IA 52246.
Mary E
ME
Charlton
D001291:Attitude of Health Personnel; D003142:Communication; D055812:Community-Based Participatory Research; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D010348:Patient Care Team; D011320:Primary Health Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D019035:Rural Health Services; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans