Clinical Summary
Clinical Summary: Primary Users of the VA Health Care System: Prevalence, Correlates, and Implications for Care Delivery
Veterans who rely on the VA as their main health system are often the ones carrying the highest psychiatric, medical, cognitive, and social burden. Knowing who these primary VHA users are helps clinicians anticipate multimorbidity, barriers to engagement, and the need for integrated, trauma-informed care.
Design
The present study analyzed data from a nationally representative sample of community-dwelling US veterans
N
4,069 US veterans
Population
a nationally representative sample of community-dwelling US veterans
Duration
2019–2020
Key Findings
- Overall, among 4,069 participants, 20.5% (95% CI, 18.9–22.3%) reported that VHA was their main source of health care.
- Only 13.8% of primary VHA users reported having insurance through a current or former employer compared to nearly half (48.5%) of non-VA users.
- In a planned post hoc analysis of individual provider-diagnosed medical conditions, chronic pain (odds ratio [OR]=1.45; 95% CI, 1.18–1.78), sleep disorders (OR =1.38; 95% CI, 1.13–1.70), and respiratory disorders (OR =1.31; 95% CI, 1.01–1.71) were independently associated with primary VHA health care use, while all other conditions were nonsignificant (Ps>.23).
- The majority of the explained variance in primary VHA utilization (Nagelkerke R2 = 0.23) was accounted for by annual household income ≤$60,000 (23% relative variance explained [RVE]), lower self-reported cognitive functioning (14% RVE), younger age (11%), unmarried/unpartnered status (10%), lifetime history of MDD (9%), chronic pain (9%), lifetime history of PTSD (7%), and a sleep disorder diagnosis (6%).
- Primary VHA use increased relative to prior national data, with 1 of 5 veterans using VHA as their main source of care in this sample versus 16.9% in 2011.
Clinical Bottom Line
Primary VHA users are a clinically vulnerable subgroup with disproportionate psychiatric, medical, cognitive, and financial burden. Care for veterans who rely on VHA should be organized around integrated management of multimorbidity, trauma-related conditions, and practical barriers to engagement.
Practice Implications
- Screen for depression, PTSD, suicide risk, chronic pain, sleep disorders, and respiratory illness early when veterans identify the VA as their main source of care, because these conditions were more common among primary VHA users and several were independently associated with VHA reliance.
- Assess cognitive functioning and build in care navigation, simplified instructions, caregiver involvement, or case management support, as lower self-reported cognitive functioning accounted for 14% RVE in primary VHA utilization.
- Ask directly about financial strain, insurance status, transportation, and scheduling barriers, since annual household income ≤$60,000 was the strongest contributor to utilization in the model at 23% RVE and employer-based insurance was far less common in primary VHA users.
- Use trauma-informed, engagement-focused approaches when discussing mental health treatment, because primary VHA users reported greater perceptions of stigma, logistical barriers, worries that mental health treatment does not work, and distrust of mental health professionals.
