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Rural and Urban Women Veterans: Health Care Needs and Use of VA Care
Mengeling M, Booth BM, Torner J, Sadler AG. Rural and Urban Women Veterans: Health Care Needs and Use of VA Care. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 29; Little Rock, AR.
To identify potential differences by rurality in current health status and care seeking of women veterans.
1004 women veterans (ages 20 - 52) participated in a retrospective cohort study of current health, health risk behaviors, sexual assault history and health care utilization. Participants had enrolled in Iowa City, Des Moines Veterans Administration Medical Centers or their outlying clinics within the 5 years preceding research interview. FY2008 VA PSSG data was used to assign subject rurality and FY2008 patient-level data was used to quantify current VA health care use.
54% of women were rural inhabitants (53.6% rural and .4% highly rural) but 22 subjects were excluded because of missing urban/rural code, resulting in N = 982 for analyses. On average participants were young (mean 38 yrs), white (80%), had post high school training (85%) and lower incomes (median $21,750). We found no rural/urban differences in PTSD (24.9% v 24.8%), depression (31.7% v 29.1%), substance abuse (34.7% v 34.6%), or in-military sexual assault (MST) (24.9% v 24.8%). Travel time to VA care was greater for rural women: primary care, 44 v 14 minutes; subspecialty care, 92 v 56 minutes. 82.1% of the sample had at least 1 VA health care visit in FY2008 and there was no difference by rurality (83.4% rural/81.0% urban). Of VA users, urban veterans did not have significantly more total VA visits (26.2 v 23.4, p = .2078) but did have slightly more Primary Care visits (3.8 v 3.3, p = .0193). Significant differences in the total number of all VA and VA primary care health care visits were found for women with current PTSD diagnoses (34.5 v 21.1, p < .001; 4.0 v 3.4, p = .0134), depression (33.1 v 20.6, p < .0001; 4.0 v 3.3, p = .0047), and MST (34.4 v 21.1, p < .0001; 4.0 v 3.4, p = .0076). For substance abuse, there was a significant difference in number of total visits (27.9 v 23.0, p = .0305) but no difference in number of primary care visits (3.7 v 3.5, p = .3181). Self reports of care received somewhere other than the VA in the past 5 years showed no significant differences by rural v urban for urgent care (41.5% v 43.4%), women's health care (52.4% v 51.3%), and mental health care (19.4% v 21.2%).
Our findings provide evidence that a veteran's health care need is a better indicator of VA health care use than distance to VA facility. Women veterans with mental health concerns are likely to have 1.5 times the number of annual VA health care visits compared to service members without mental health concerns, regardless of rurality.
Travel time is a potential barrier to care. Veterans with PTSD, depression, MST, or substance abuse health care needs had nearly 1.5 times more VA visits and the average travel time for a rural veteran was over 90 minutes for the majority of their visits. Additional investigation may identify services that could be offered in primary care clinics and thus shorten travel time for rural veterans.