title: Utilization of Care Outside the Veterans Affairs Health Care System by US Veterans With Rheumatoid Arthritis.
abstract: Many veterans enrolled in Veterans Affairs (VA) health care systems also receive care through other health care systems. Both VA and non-VA health care use must therefore be considered when conducting research in this population. This study characterized dual-care utilization in veterans with rheumatoid arthritis (RA) and explored associations with RA disease activity.
  
  
  
  Through a questionnaire mailed to RA patients at 3 VA sites, veterans reported medical services by non-VA primary care and subspecialty providers, comorbidities, non-VA medications, and hospitalizations. Disease Activity Score in 28 joints (DAS28) and Multidimensional Health Assessment Questionnaire (MD-HAQ) scores were recorded during VA clinic visits, and respondent groups were compared.
  
  
  
  Of the 510 participants surveyed, 318 (62%) responded. Respondents were older (ages 69 versus 66 years; P = 0.006), more likely nonsmokers (80% versus 67%; P = 0.001), and had lower disease activity (DAS28 3.3 versus 3.8; P < 0.001, MD-HAQ 0.8 versus 0.9; P = 0.01) than nonrespondents (n = 192 [38%]). The respondents with a non-VA provider (n = 130 [41%]) were older (71 versus 68 years; P = 0.001) and had more education (14 versus 13 years; P = 0.021) than nondual-care users. Only 6% of respondents reported having a non-VA rheumatologist, with 2% receiving a non-VA prescribed biologic agent or disease-modifying antirheumatic drug.
  
  
  
  In this study, VA beneficiaries with RA had lower dual-care utilization than previously reported for the general VA population, with few patients receiving dual rheumatology care or non-VA RA medications. This survey suggests that most US veterans with RA who access VA care use the VA as their primary source of arthritis care.
authors.affiliation: VA Portland Health Care System and Oregon Health and Science University, Portland.
authors.forename: Pascale
authors.initials: P
authors.lastname: Schwab
authors.affiliation: VA Nebraska-Western Iowa Health Care System, and Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha.
authors.forename: Harlan
authors.initials: H
authors.lastname: Sayles
authors.affiliation: VA Nebraska-Western Iowa Health Care System, and Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha.
authors.forename: Debra
authors.initials: D
authors.lastname: Bergman
authors.affiliation: VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Cannon
authors.affiliation: VA Nebraska-Western Iowa Health Care System, Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, and the National Data Bank for Rheumatic Diseases, Wichita, Kansas.
authors.forename: Kaleb
authors.identifier: 0000-0002-5350-3934
authors.initials: K
authors.lastname: Michaud
authors.affiliation: VA Nebraska-Western Iowa Health Care System, and Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha.
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
authors.affiliation: VA Portland Health Care System and Oregon Health and Science University, Portland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data* / Q000639:trends; D014728:Veterans