How to Assess Veterans Who Rely on VA as Main Care
How should clinicians assess veterans who report the VA as their main source of health care?
Veterans who rely on the VHA as their main health system represent a clinically vulnerable subgroup with more psychiatric, medical, cognitive, and social burden than veterans who do not. When a veteran identifies VA as their primary source of care, clinicians can use that information to anticipate a higher likelihood of multimorbidity and support needs.
-
Confirm whether VA is the veteran's main source of care
Ask directly whether the VA is the veteran's main source of health care, mirroring the study's defining item. In this sample, veterans were categorized as primary VHA users based on that single question, so the workflow begins by establishing whether the patient belongs to this subgroup.
-
Identify demographic and military features linked to primary VA use
Note whether the veteran is younger, black or African American, unmarried or unpartnered, has annual household income of $60,000 or less, or has combat exposure. In the multivariable model, each of these characteristics was independently associated with primary VHA utilization, and lower income accounted for the largest share of explained variance at 23%.
-
Screen for trauma burden, depression, and PTSD
Assess cumulative trauma exposure and determine whether there is a history of major depressive disorder or PTSD. These psychiatric factors were independently associated with primary VHA use, and primary VHA users also had higher suicide risk indicators in bivariate analyses, including past-year suicidal ideation, lifetime nonsuicidal self-injury, suicide attempts, and future suicidal intent.
-
Review multimorbidity with attention to pain, sleep, and respiratory illness
Assess the total burden of medical conditions and specifically ask about chronic pain, sleep disorders, and respiratory disorders. A greater number of self-reported medical conditions was independently associated with primary VHA use, and post hoc analyses found chronic pain, sleep disorders, and respiratory disorders to be the individual medical conditions independently linked to primary VHA use.
-
Assess cognitive and functional status
Evaluate self-reported cognitive functioning and look for broader impairment in mental, physical, and psychosocial functioning. Lower cognitive functioning was independently associated with primary VHA use and accounted for 14% of relative variance explained, while primary VHA users also had lower mental, physical, and cognitive functioning scores and higher psychosocial difficulties.
-
Plan care as integrated and support-intensive
If a veteran relies on VA as their main source of care and has this high-burden profile, organize care around integrated management of psychiatric, medical, cognitive, and social needs. The article highlights the relevance of cognitive screening, care coordination, caregiver support, trauma-informed care, and attention to social and logistical needs in this subgroup.
Clinical Considerations
- The study was observational and identifies correlates of primary VHA use rather than a causal pathway.
- Primary VHA use was defined by a single self-report item and did not distinguish veterans who used VA as a secondary source of care from those who did not use VA at all.
- All psychiatric, medical, and functional measures relied on self-report and may be affected by recall error or underreporting.
- The data were collected in 2019 to 2020 and do not capture later changes such as post-pandemic telehealth expansion.
Bottom Line
When a veteran reports the VA as their main source of care, clinicians should expect higher odds of trauma-related psychiatric illness, multimorbidity, cognitive difficulty, and social disadvantage and assess accordingly.
