Non-VA Primary Care Providers' Perspectives on Comanagement for Rural Veterans

Background: Many veterans utilize health care services within and outside of the Department of Veterans Affairs (VA). There are limited VA care coordination resources for non-VA primary care providers (PCPs), and the non-VA provider perspective on caring for veterans is underrepresented. The VA requires Patient Aligned Care Teams to coordinate care for veterans across health systems. Objective: To elicit perspectives of PCPs on caring for veterans who use both VA and non-VA health care. Methods: Qualitative data from semistructured telephone interviews were interpreted in the context of quantitative survey results. Participants were PCPs in a practice-based research network in 2011. 67 non-VA PCPs completed surveys, and descriptive statistics were performed. 21 semistructured telephone interviews were transcribed and underwent thematic analysis. Results: Current communication with VA was viewed as poor, and many believed this led to poor patient outcomes. The veteran was identified as the main vehicle for information transfer between providers, which was viewed as undesirable. Non-VA providers felt they were interacting with VA as a system rather than with individual providers. Conclusions: VA system barriers hinder communication between providers, possibly resulting in fragmented care. Addressing these barriers will potentially improve patient safety and satisfaction.