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RRP 07-344 – HSR Study

 
RRP 07-344
Access to Specialty Care Veterans with MS: Assessment and Intervention
Jodie K. Haselkorn, MD MPH
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: October 2008 - December 2009
BACKGROUND/RATIONALE:
Multiple Sclerosis (MS) is a demyelinating and axonal disease of the brain and spinal cord that usually has its onset in young adulthood and often progresses over a nearly normal life span. Given the uncertain but progressive feature of MS, health care providers and administrators recommend an annual visit to a MS specialty care provider (neurology or physical medicine and rehabilitation).

OBJECTIVE(S):
This research examines potential barriers to the implementation of this recommendation in the Veterans Health Administration and reports the results of a brief pilot intervention to improve attendance. Main Outcome Measures: Study 1: Specialty care visit, receipt of medical services. Study 2: Attendance at a specialty care appointment within three months following an invitation and educational letter.

METHODS:
Study 1: Observational cohort study. Study 2: Randomized controlled trial. Setting: Veterans Health Administration (VHA).

Participants in Study 1 were drawn from the Veterans Affairs MS National Data Repository and included Veterans if they had an outpatient visit in 2007 and alive in 2008 (N=14,723).

Participants in Study 2 included Veterans with MS from the Northwest region of U.S. who did not receive a specialty care visit. They were randomly assigned to receive an invitation letter to schedule a specialty care appointment (N = 101) or to usual care (N=73).

FINDINGS/RESULTS:
Study 1: 65.5 percent (n=9,643) had a specialty care visit in 2007. Veterans who were service-connected, had greater medical comorbidity and lived in urban settings were more likely to have received a specialty care visit. Veterans who were older and had to travel greater distances to a center were less likely to have a specialty care visit.

Study 2: Attendance at a specialty care visit was significantly higher in the intervention condition (11.1%) compared to the control condition (2.7%). Access to care in rural areas and areas at greater distance from a major medical center represents a notable barrier. A brief provider-initiated contact letter facilitated engagement in care, but primarily among those who were not limited by other obstacles.

IMPACT:
This preliminary work will assist in the development of models of service delivery designed to improve access to MS care and improve adherence to current standards of care within VHA.



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PUBLICATIONS:

None at this time.


DRA: Other Conditions
DRE: Treatment - Observational
Keywords: Access, Chronic disease (other & unspecified)
MeSH Terms: none

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