Abstract:
BACKGROUND:The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with referrals are not well understood. OBJECTIVE:To understand VA PCPs' experiences referring patients to community specialists while VA works to expand and refine the implementation of the Choice Program. DESIGN:Qualitative study using interview methods. PARTICIPANTS:Semi-structured telephone interviews were conducted with VA primary care providers (N = 72 out of 599 contacted) recruited nationally. APPROACH:Open-ended interview questions elicited PCP perceptions and experiences with referrals to community specialists via the Choice Program. Keywords were identified using automated coding features in ATLAS.ti and evaluated using conventional content analysis to inductively describe the qualitative data. KEY RESULTS:VA PCPs emphasized problems with care coordination and continuity between the VA and community specialists (e.g., "It is extremely difficult for us to obtain and continue continuity of care because there's not much communication with the community specialist"). They described difficulties with tracking the initial referral, coordinating care after receiving community specialty care, accessing community medical records, and aligning community specialists' prescriptions with the VA formulary. CONCLUSIONS:The VA Choice Program provides access to community specialists for VA patients; however, VA primary care providers face challenges tracking referrals to community specialists and in coordinating care. Strategies to improve care coordination between the VA and community providers should focus on providing PCPs with information to follow Veterans throughout the Choice referral process and follow-up.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Nevedal AL,Wagner TH,Ellerbe LS,Asch SM,Koenig CJdoi
10.1007/s11606-018-4810-2subject
Has Abstractpub_date
2019-04-01 00:00:00pages
598-603issue
4eissn
0884-8734issn
1525-1497pii
10.1007/s11606-018-4810-2journal_volume
34pub_type
杂志文章abstract:BACKGROUND:Women veterans are generally less healthy than their nonveteran female counterparts or male veterans. Accumulating evidence suggests there may be barriers to women veterans' access to and use of Veterans Health Administration (VHA) care. OBJECTIVE:To document perceived and/or actual barriers to care in a na...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00370.x
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-015-3488-y
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVES:To examine the extent and type of discordance between personal and medical classifications of weight status, and to examine the influence of sociodemographic factors on the misclassification of weight status. DESIGN/SETTING:The 1991 Health Promotion and Disease Prevention Supplement of the National Health I...
journal_title:Journal of general internal medicine
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doi:10.1046/j.1525-1497.2001.016008538.x
更新日期:2001-08-01 00:00:00
abstract:BACKGROUND:Patients with mental health conditions (MHCs) experience poor anticoagulation control when using warfarin, but we have limited knowledge of the association between specific mental illness and warfarin treatment outcomes. OBJECTIVE:To examine the relationship between the severity of MHCs and outcomes of anti...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-2784-2
更新日期:2014-06-01 00:00:00
abstract::People with type 2 diabetes often experience two common mental health conditions: depression and diabetes distress. Both increase a patient's risk for mortality, poor disease management, diabetes-related complications, and poor quality of life. The American Diabetes Association and the U.S. Preventive Services Task Fo...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-018-4705-2
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Veterans commonly receive care from both Veterans Health Administration (VA) and non-VA sources (i.e., dual use). A major challenge in comparing health outcomes between dual users and VA-predominant users is applying an accurate method of risk adjustment. OBJECTIVE:To determine how different comorbidity ind...
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更新日期:2017-09-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-0916-x
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:Enhancing the cultural competency of students is emerging as a key issue in medical education; however, students may perceive that they are more able to function within cross-cultural situations than their teachers, reducing the effectiveness of cultural competency educational efforts. OBJECTIVE:The purpose...
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doi:10.1007/s11606-007-0177-5
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVE:To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). DESIGN:Retrospective review of echocardiograms and clinical records. SETTING:Military tertiary care hospital. PATI...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600871
更新日期:1990-11-01 00:00:00
abstract::We surveyed employers of general internists at teaching hospitals to determine whether they prefer that new hires are graduates of general internal medicine (GIM) fellowships. We surveyed former GIM fellows who graduated between 1988 and 1994 to determine whether they found jobs with protected research time and whethe...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00121.x
更新日期:1998-06-01 00:00:00
abstract::The clinical presentation of lead intoxication may vary widely and in the absence of a high clinical index of suspicion, the diagnosis may be missed. The effects of lead on mitochondrial oxidative phosphorylation and its interaction with calcium-mediated processes explain the heterogenous presentation. In this case re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00328.x
更新日期:2006-06-01 00:00:00
abstract::This report examines alternative methods of paying for clinical preventive care services. First, the extent of coverage of preventive health care services in public and private health insurance plans is reviewed. Included in this review are Medicare, Medicaid, health maintenance organizations, and private health insur...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600851
更新日期:1990-09-01 00:00:00
abstract:BACKGROUND:Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-015-3558-1
更新日期:2016-04-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3564-3
更新日期:2016-04-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0467-y
更新日期:2008-04-01 00:00:00
abstract::Reflective capacity has been described as an essential characteristic of professionally competent clinical practice, core to ACGME competencies. Reflection has been recently linked to promoting effective use of feedback in medical education and associated with improved diagnostic accuracy, suggesting promising outcome...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-010-1347-4
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care. OBJECTIVE:To test the effectiveness of portal and IVR outreach in improving rates of influenza...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-017-4266-9
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVE:To use spatial and epidemiologic analyses to understand disparities in mammography use and to formulate interventions to increase its uptake in low-income, high-recent immigration areas in Toronto, Canada. DESIGN:We compared mammography rates in four income-immigration census tract groups. Data were obtained...
journal_title:Journal of general internal medicine
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doi:10.1111/j.1525-1497.2004.30270.x
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. OBJECTIVE:To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. DESIGN:Randomized two-group design. PARTICIPANTS:121 ...
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pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-014-3113-5
更新日期:2015-03-01 00:00:00
abstract::In rare cases, pancytopenia results from hormonal deficiencies that arise in the setting of panhypopituitarism. Here we describe the unusual case of a 60-year-old man who presented with progressive fatigue and polyuria, and whose laboratory workup revealed a deficiency of the five hormones associated with the action o...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
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pub_type: 杂志文章
doi:10.1007/s11606-012-2007-7
更新日期:2012-06-01 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1998.00246.x
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening. OBJECTIVE:Compare the effectiveness of a commitment devic...
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doi:10.1007/s11606-020-06392-y
更新日期:2021-01-20 00:00:00
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
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更新日期:2015-05-01 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s11606-019-04894-y
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:We compare preventive services utilization among privately insured African Americans and Hispanics in managed care organizations (MCOs) versus fee-for-service (FFS) plans. We also examine racial/ethnic disparities in the receipt of preventive services among enrollees in FFS or MCO plans. DESIGN:Analysis of t...
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pub_type: 杂志文章
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更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:Studies on forgoing treatment often ignore treatments that are continued until death. OBJECTIVE:To investigate how often specific treatments are withdrawn or withheld before death and to describe the associated patient, physician, and care characteristics. DESIGN:National mortality follow-back study in Swi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05344-5
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. OBJECTIVE:This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacolog...
journal_title:Journal of general internal medicine
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更新日期:2018-05-01 00:00:00
abstract:OBJECTIVES:To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care. DESIGN:Cross-sectional qualitative interview study of primary care physicians. SETTING:Physicians' offices. PARTICIPANTS:Forty...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0317-y
更新日期:2007-11-01 00:00:00