The impact of patient–provider relationships on choosing between VA and VA‐purchased care: A qualitative study of health care decision‐making among rural veterans

• Published in: The Journal of rural health 2024-06, Vol.40 (3), p.430-437
• Main Authors: Ball, Daniel D., Sadler, Anne G., Steffen, Melissa J., Paez, Monica B., Mengeling, Michelle A.
• Format: Article
• Language: English
• Subjects: access to care; Adult; Aged; Belonging; Clinical decision making; Decision Making; Decisions; Employee turnover; Familiarity; Female; Health care; health care decision‐making; Health services; Help seeking behavior; Humans; Interviews; Interviews as Topic - methods; Male; Middle Aged; Patients; patient–provider relationships; Qualitative Research; quality of care; Rural areas; Rural communities; Rural Population - statistics & numerical data; rural veterans; Social relations; United States; United States Department of Veterans Affairs - organization & administration; United States Department of Veterans Affairs - statistics & numerical data; Veterans; Veterans - psychology; Veterans - statistics & numerical data
• ISSN: 0890-765X; 1748-0361; 1748-0361
• DOI: 10.1111/jrh.12804

Purpose Since the Choice Act in 2014, many Veterans have had greater options for seeking Veteran Affairs (VA)‐purchased care in the community. We investigated factors that influence rural Veterans’ decisions regarding where to seek care. Methods We utilized semi‐structured telephone interviews to query Veterans living in rural or highly rural areas of Midwestern states about their health care options, preferences, and experiences. Interviews were recorded and transcribed, thematically coded, and deductively analyzed using a socioecological approach. Findings Forty rural Veterans (20 men/20 women) ages 28–76 years completed interviews in 2019. We found that rural Veterans often spoke about their relationships and interactions with providers as an important factor in deciding where to seek care. They expressed three socioecological qualities of patient–provider relationships that affected their decisions: (1) personal level—rural Veterans traveled longer distances for more compatible patient–provider relationships; (2) interpersonal level—they sought stable patient–provider relationships that encouraged familiarity, trust, and communication; and (3) organizational level—they emphasized shared identities and expertise that fostered a sense of belonging with their provider. Participants also described how impersonal interactions, status differences, and staff turnover impacted their choice of provider and were disruptive to patient–provider relationships. Conclusions Rural Veterans’ interview responses suggest exploring innovative ways to measure socioecological dimensions (i.e., personal, interpersonal, and organizational) of access‐related decisions and patient–provider relationships to better understand health care barriers and needs. Such measures align with the VA's Whole Health approach that emphasizes person‐centered care and the value of social relationships to Veterans’ health.