Houston TK (Birmingham VAMC)
Allison JJ (Birmingham VAMC)
Kiefe CI (Birmingham VAMC)
Objectives: To compare differences over time in receipt of indicated preventive health services among Veterans treated within the VHA (VetVAs), Veterans not treated within the VHA (VetNonVAs), and Non-Veterans (NonVets).
We used national data from the CDC’s 2000 and 2003 Behavioral Risk Factors Surveillance Surveys (BRFSS). Participants identified whether they were Veterans, and whether they were received treatment within VHA. We identified ideal candidates among those asked about: cholesterol screening, smoking cessation counseling, mammography, pap test, pneumococcal and influenza vaccination, (e.g., ideal candidates for mammography were women 40 years old). Differences in receipt of services were assessed using survey-weighted logistic regression analyses adjusted for age, ethnicity, income, education, general health status, health insurance, time since last provider visit (and sex when appropriate).
BRFSS 2000 included 3,391 VetVAs, 22,791 VetNonVAs, and 156,331 NonVets. Mean age was 46 (SD 17), with 59% female, 78% white, 8% African-American, and 16% reported fair/poor health. Unadjusted, VetVAs more frequently reported preventive services; e.g., among 67,201 women over 40, the weighted proportion receiving mammograms was 88% among NonVets, 90% among VetNonVAs, and 96% among VetVAs. After adjustment, compared with NonVets, VetVAs were significantly more likely to receive mammograms, Odds Ratio 2.78 (95% CI 1.05-7.33); cholesterol screening, OR 2.73 (95% CI 1.5-4.9); smoking cessation counseling, OR 4.56 (95% CI 2.62-7.93); pneumococcal vaccination, OR 2.08 (95% CI 1.22-3.56), but not pap test or flu shot. Compared with VetNonVAs, VetVAs were again more likely to receive cholesterol screening, smoking counseling, and pneumococcal vaccination. In the 2003 BRFSS data, differences among VetVAs and NonVets were consistent and even greater; e.g. for cholesterol, OR 3.34 (95% CI 2.55-4.36), and pneumovax OR 3.35 (95% CI 2.76-4.07).
Veterans with VHA care are more likely to receive preventive health services than Veterans not receiving care in VHA and non-Veterans. This trend appears to be increasing with time.
Increasing the proportion of Veterans treated within VHA may prevent future morbidity and mortality. Future research by the VHA, NIH and CDC is needed to identify exportable systems approaches to preventive care developed within the VA.