A Triangulated Qualitative Study of Veteran Decision-Making to Seek Care During Heart Failure Exacerbation: Implications of Dual Health System Use

Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases effic...

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Bibliographic Details
Published in:Inquiry (Chicago) 2018-01, Vol.55, p.1-8
Main Authors: Pope, Charlene A., Davis, Boyd H., Wine, Leticia, Nemeth, Lynne S., Axon, Robert N.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Chronic illnesses
Content analysis
Coordination
Decision Making
Emergency medical care
Female
Grounded theory
Health care policy
Health services utilization
Heart failure
Heart Failure - therapy
Hospitalization
Hospitals
Humans
Interviews
Male
Management
Medicare
Middle Aged
Mortality
Original Research
Patient Acceptance of Health Care - psychology
Patients
Primary care
Primary Health Care - organization & administration
Qualitative Research
Quality of Health Care - organization & administration
Referral and Consultation - organization & administration
Referrals
Safety
Time Factors
United States
United States Department of Veterans Affairs - organization & administration
Veterans
Veterans - psychology
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Summary:Among Veterans, heart failure (HF) contributes to frequent emergency department visits and hospitalization. Dual health care system use (dual use) occurs when Veterans Health Administration (VA) enrollees also receive care from non-VA sources. Mounting evidence suggests that dual use decreases efficiency and patient safety. This qualitative study used constructivist grounded theory and content analysis to examine decision making among 25 Veterans with HF, for similarities and differences between all-VA users and dual users. In general, all-VA users praised specific VA providers, called services helpful, and expressed positive capacity for managing HF. In addition, several Veterans who described inadvertent one-time non-VA health care utilization in emergent situations more closely mirrored all-VA users. By contrast, committed dual users more often reported unmet needs, nonresponse to VA requests, and faster services in non-VA facilities. However, a primary trigger for dual use was VA telephone referral for escalating symptoms, instead of care coordination or primary/specialty care problem-solving.
ISSN:0046-9580
1945-7243
DOI:10.1177/0046958017751506