Accessibility and acceptability of the Department of Veteran Affairs health care: diverse veterans' perspectives

OBJECTIVES: Diverse veteran's perspectives on the accessibility and acceptability of the Department of Veteran Affairs (VA) health services are presented. METHODS: The qualitative methodology uses 16 focus groups (N = 178) stratified by war cohort (World War II and Korean Conflict versus Vietnam War and Persian Gulf War) and four ethnic/racial categories (African American, Asian American, European American, Hispanic American). RESULTS: Five themes emerged regarding veterans' health care expectations: (1) better information regarding available services, (2) sense of deserved benefits, (3) concern about welfare stigma, (4) importance of physician attentiveness, and (5) staff respect for patients as veterans. Although veterans' ethnic/racial backgrounds differentiated their military experiences, it was the informants' veteran identity that framed what they expected of VA health services. CONCLUSIONS: Accessibility and acceptability of VA health care is related to veterans' perspectives of the nature of their entitlement to service. Provider education and customer service strategies should consider the identified factors to increase access to VA as well as improve veterans' acceptance of the care.     

Oral health disparities between ranks in a military environment: Israel Defense Force as a model

Some studies have demonstrated a relationship between occupational status and position in the workplace to use of dental services and oral health status. Ranks symbolize social status in the military hierarchy, which is different from that accepted in civilian workplace. OBJECTIVE: This study was aimed at analyzing differences between officers and noncommissioned personnel in regard to dental treatment needs and use of dental services. METHODS: One-thousand, one-hundred thirty-nine personnel of the Israel Defense Force were examined, using DMFT (decayed, missing, filled permanent teeth and CPITN (community periodontal index of treatment needs indices to define oral health status. A questionnaire was used to calculate utilization rates. RESULTS: Noncommissioned personnel had on average 50% more unmet caries treatment needs, and 19.1% of them suffered from deep periodontal pockets. No differences were demonstrated in utilization rates CONCLUSIONS: Military rank influences oral treatment needs the way civilian organizational structure does with the exception of utilization rates of dental services.     

Veterans' care preference for coronary artery bypass grafting in a rural setting

We wanted to determine what factors were associated with rural veterans' use of Department of Veterans Affairs (VA) facilities over the private sector for coronary artery bypass grafting (CABG) surgery. We reviewed the charts of 137 veterans who were referred for CABG by their VA cardiologists. Most veterans (69%) obtained CABG through the VA system. Although patients who had to drive fewer additional miles to obtain VA care were somewhat more likely to use the VA system, patients who lacked insurance or faced high out-of-pocket cost estimates for care in the private sector obtained care through the VA at dramatically higher rates. Although patients using the VA system were younger and more likely to have significant coronary artery disease, clinical outcomes did not significantly differ across systems of care. As the VA begins to understand veterans' use of multiple systems of care, it will be important to understand what influences veterans' choice of VA or private sector care.     

Screening tools to prioritize routine dental care in an institutional environment

OBJECTIVE: This study examines whether self-rated oral health is a suitable screening tool to detect dental caries and periodontal pockets, by itself and in combination with other self-reported health indicators, at the entry point of an institutional system for routine dental care. METHODS: Eight dentists recorded the clinical oral health status of a diverse adult sample (#n = 483) demanding routine dental examinations from a military health maintenance organization in South Africa (July 1999 to December 2000). Additionally, subjects reported their smoking status and rated their general and oral health by using a 4-point Likert scale (excellent, good, fair, or poor). RESULTS: Self-rated oral health in combination with self-reported smoking and self-rated general health were associated with the majority of decayed teeth and periodontal pockets in subjects demanding routine dental examinations. CONCLUSION: This study indicates that self-rated oral health in combination with self-reported smoking can be a useful screening tool to prioritize routine dental care in an institutional environment.     

辽宁省特殊教育学校学生口腔健康状况的调查比较

目的探讨具有智力障碍、肢体障碍、聋哑盲人群的对口腔健康知识知晓情况、口腔保健行为执行情况,以及龋病、牙周疾病等发生情况,指导该类人群口腔预防保健。方法通过对辽宁省特殊教育学校202名学生(A组)和沈阳市广全中学同龄202名学生(B组)发放调查问卷,并对口腔健康状况进行检查,了解两组调查对象口腔健康知识和行为的状况,比较其龋病、牙龈炎和牙结石的发病率。结果 A组学生的龋病、牙龈炎、牙结石患病率分别为61.4%、53.0%、31.4%,与B组比较,差异有统计学意义(P<0.01)。结论辽宁省特殊教育学校学生的口腔健康状况不佳,需要加强对他们的口腔宣传教育和预防保健,提高其口腔健康水平。     

"和谐使命-2010"任务期间口腔疾病就诊情况分析

目的 初步调查海军护航人员口腔医疗需要,并了解亚非等欠发达国家的华侨和当地民众的口腔健康概况.方法 根据临床检查结果分类记录,并进行统计和分析.结果 阻生智齿和可能由此引起的智齿冠周炎是我海军护航人员最常见的口腔疾病,其次是龋病及其继发病和牙体硬组织缺损.华人华侨的口腔健康状况好于当地民众,当地民众的口腔健康状况相对较差,可以见到罕见病例和常见病中的少见类型.结论 海军护航任务人员需要进行专门的口腔卫生勤务服务,做到执行任务前普查普治.与当地民众相比,华人华侨文化背景和经济收入是其口腔健康状况相对较好的重要因素.不同国家的人均经济收入水平、国家医疗保障制度对当地民众的口腔健康状况有重要影响.

Abstract：

Objective To investigate the medical demands of oral health care for naval escort personnel and find out the oral health status of the Chinese, overseas Chinese and local people in the Asian -African underdeveloped countries. Methods Based on the results obtained from clinical examinations, data were recorded, sorted, and analyzed by using Excel. Results Impacted wisdom tooth and resulting pericoronitis was the most prevalent oral disease that prevailed among the naval escort personnel. The less prevalent disease was dental caries and secondary pulpitis and apical periodontitis. Dental hard tissue defect was the last most popular disease. The oral health status of Chinese and overseas Chinese was better than that of the local people. Unusual cases or hardly observed categories of unusual cases were seen among the local people. Conclusions Specialized oral medical service was required for the naval escort personnel, who should have medical screening and receive dental treatment before deployment. When compared with the local people, the cultural background and economic income of the Chinese and overseas Chinese were 2 most influential factors for their better oral health status. Per capita income levels and national heath care system in different countries had great effect on the oral health status of the local people.     

"和谐使命-2010"任务期间口腔疾病就诊情况分析

目的 初步调查海军护航人员口腔医疗需要,并了解亚非等欠发达国家的华侨和当地民众的口腔健康概况.方法 根据临床检查结果分类记录,并进行统计和分析.结果 阻生智齿和可能由此引起的智齿冠周炎是我海军护航人员最常见的口腔疾病,其次是龋病及其继发病和牙体硬组织缺损.华人华侨的口腔健康状况好于当地民众,当地民众的口腔健康状况相对较差,可以见到罕见病例和常见病中的少见类型.结论 海军护航任务人员需要进行专门的口腔卫生勤务服务,做到执行任务前普查普治.与当地民众相比,华人华侨文化背景和经济收入是其口腔健康状况相对较好的重要因素.不同国家的人均经济收入水平、国家医疗保障制度对当地民众的口腔健康状况有重要影响.     

Elite athletes and oral health

Elite athletes follow demanding training regimes to achieve optimal performance. Training incorporates strategies which coincide with risk factors for dental caries and erosion. The important role of a disease-free oral cavity for peak performance is often overlooked and oral health may be compromised. This initial exploratory study aimed to identify risk factors for dental caries and erosion in elite triathletes. Questionnaires regarding training, diet and oral health were distributed to a sample of elite triathletes in New Zealand. A further sample of 10 athletes was randomly selected from the Dunedin triathlon club to participate in a clinical oral examination. Sports drinks were consumed by 83.9% of the triathletes while training; for 48.4% consumption of both sports drinks and water was described as 'little sips often, from a bottle'. Eating during training sessions was reported by 93.5% of participants; of those 62.1% ate only during cycling training. Only 3.2% perceived training as high risk to oral health. All clinical examination cases were assessed as high risk for developing caries. The diet of elite triathletes is consistent with a high risk profile for caries and erosion. Future research should be aimed at oral health promotion programs for the athletes, coaches and oral-health providers.     

Determinants of hormone therapy discontinuation among female veterans nationally

PURPOSE: The growing presence of female veterans within the Department of Veterans Affairs (VA) health care system highlights the need to assess the quality of and access to gender-specific care for menopause. We assessed the use of hormone therapy (HT) among female veterans before and after the release of the Women's Health Initiative clinical trial results and evaluated whether the structure of women's health care services within the VA system affects the use of HT. METHODS: We identified all female veterans using HT in 2001 by using the VA pharmacy benefits management database and administrative data. Subjects identified as using HT in 2001 were evaluated to determine estrogen use status in 2003 and 2004. We calculated the change in HT use over time and performed multivariate analyses to identify patient and utilization determinants of HT discontinuation. RESULTS: In 2001, 36,222 female veterans used HT. By 2004, 23,924 (66%) had discontinued HT. Subjects who had used a VA women's clinic or were younger (40-54 years of age) were significantly less likely to discontinue HT. However, Hispanic ethnicity, African American race, and clinical diagnoses such as heart disease and mastectomy were significantly associated with discontinuation. CONCLUSION: Discontinuation rates in the VA system parallel those in the private sector. However, patients with any use of VA women's clinics were less likely to discontinue HT, indicating a practice setting variation that may indicate either more specific care or differential implementation of the new HT guidelines. Further research is warranted to assess whether a disparity occurs according to practice setting (or provider factors) with rapid shifts in guidelines.     

陕西省5岁儿童龋病流行病学抽样调查分析

目的了解陕西省5岁儿童口腔健康状况，监测龋病的患病趋势，为儿童龋病防治提供科学依据。方法按照第三次全国口腔健康流行病学调查的要求，对陕西省城乡6个地区的786名5岁儿童进行了口腔健康状况调查。采用SPSS13．0软件包对数据进行分析。结果5岁儿童的患龋率和龋均分别为58．78％和2．23。农村和城市地区的患龋率分别为59．42％和58．06％。患龋率在农村和城市、男性和女性之间的差异经统计学检验均无显著性差异（P〉0.05）。5岁儿童有96．9％的龋齿未经治疗。结论陕西省学龄前儿童的口腔健康状况不容忽视，应采取各种有效预防措施，控制龋病的发生。提高充填率，改善口腔健康状况。     

某部老干部患龋状况分析

目的了解部队老干部恒牙龋病的发生情况,为进一步搞好老干部龋病的预防保健工作提供依据。方法按照1997年WHO《口腔健康调查基本方法》,对某部568名老干部的口腔健康状况进行现况调查,主要通过问诊、视诊、探诊`等方法做检查,并进行统计学分析。结果老干部患龋率为52.46%,龋齿充填率为25.93%,女性老干部龋齿充填率高于男性老干部;部队老干部患龋率低于地方同龄组,龋齿充填率高于地方同龄组。结论部队老干部患龋率高,充填率较低,需加强口腔疾病和卫生保健知识的宣传,整体提高部队老干部的口腔健康状况水平。     

168名军队离退休老干部口腔卫生状况调查分析

目的　了解我军离退休老干部的口腔卫生健康状况。方法　对驻厦门部队干休所 168名军队离退休老干部进行口腔卫生健康检查。结果　168名军队离退休老干部中人均龋齿未补牙数为 0. 23,楔缺未补牙数为 1. 53,人均残根数为 1 09,缺失牙数为 7. 57,松动牙数为 0. 35。结论　军队离退休老干部的人均龋齿和人均缺失牙数稍好于全国调查水平,但口腔卫生状况不容乐观,仍需努力把军队离退休老干部的口腔预防保健工作做好。     

Innovation in veterans' health care and assistance: the Department of Veterans Affairs 10 years after the Gulf War

The Department of Veterans Affairs (VA) has responded to significant challenges in treating and compensating Persian Gulf War veterans by adapting existing programs and developing new ones. The VA established a Gulf War health examination registry and expanded existing "Vet Centers" to provide assistance to Gulf War veterans. Health care eligibility income limitations were eliminated. Outreach efforts included a national newsletter, veterans' organization briefings, and other products. The VA is developing targeted training programs and continuing medical education for health care providers. Numerous major research initiatives have begun. Innovations include the establishment of environmental hazards research centers, clinical demonstration projects, and centers for the study of war-related illness. These efforts required increased coordination among federal agencies and collaboration with other countries. In a precedent-setting development, Congress gave the VA authority to compensate certain veterans with undiagnosed illnesses. Veterans from future conflicts and peacekeeping missions can expect improved services from the VA as a result of these initiatives.     

萍乡市中小学生龋齿和氟牙症流行病学调查

目的：了解萍乡市中小学生龋齿及氟牙症的流行病学情况,为制定口腔防治规划提供参考依据。方法：按照1997年WHO《口腔健康调查基本方法》,参照第三次全国口腔健康流行病学抽样调查方案,对江西省萍乡市36 804名中小学生的口腔健康状况进行调查,检查项目包括龋病和氟斑牙,将调查结果与97年萍乡市学生龋齿和氟牙症流行病学调查进行比较。结果：患龋率为47.95%,龋均1.13,氟斑牙占7.05%。与97年萍乡市中小学生龋齿和氟牙症流行病学抽样调查结果相比,患龋率、龋均和氟斑牙的患病率差异均有统计学意义（P〈0.01）。结论：江西省萍乡市中小学生龋齿患病率仍然较高,氟斑牙的检出率明显降低,应加强中小学生龋病的防治工作和口腔卫生宣传教育,降低龋病的发生,促进口腔健康。     

Women veterans' perceptions and decision-making about Veterans Affairs health care

The increase in women in the military is reshaping the veteran population and Veterans Affairs (VA) health care delivery imperatives. To determine women veterans' perspectives and decision-making about VA health care use, we conducted six focus groups (four VA users and two nonusers) and identified key themes. Barriers to VA use for both VA users and nonusers included lack of information about eligibility and available services. Nonusers often assumed the VA did not provide women's health care. All groups emphasized they required a health care system focused on quality and sensitivity to women's health issues. However, users and nonusers differed in perceptions of VA quality. VA environment and quality concerns led many women to limit their VA use to women's clinics. These qualitative findings provide a context to highlight where interventions and policies suggested by quantitative findings should focus. Dissemination of accurate information about VA eligibility and services, and continued responsiveness to women's perceptions of care are indicated.     

Does filing a post-traumatic stress disorder disability claim promote mental health care participation among veterans?

This study examined the impact of participation in the Department of Veterans Affairs (VA) disability system on health care use by veterans filing disability claims on the basis of post-traumatic stress disorder (PTSD). VA administrative databases were used to examine health care use in 3-month intervals before, during, and after veterans' filing of PTSD disability claims. Subjects were all veterans using some VA health care who filed PTSD claims between 1997 and 1999 in a large Midwestern region. PTSD claimants used more medical and mental health services after filing a disability claim, compared with the preapplication period. Continuation of elevated mental health care use after claim determination occurred only for those veterans whose claims were approved. Use of VA mental health care before the disability examination was associated with an increased likelihood of claim approval. For veterans with PTSD, disability system participation may both promote and be promoted by receipt of mental health care.     

Risk for increased utilization and adverse health outcomes among men served by the Veterans Health Administration

Using data from a nationally representative survey, we evaluated the prevalence of multiple risk factors known to predict increased health care utilization and adverse health outcomes, comparing U.S. men who rely solely on the Veterans Affairs Health Administration (VA) for health care to men in the general population. Adjusting for age and race, men who only use the VA were significantly more likely to have multiple socioeconomic and lifestyle risk factors including current smoking. Their self-reported health status was more often fair or poor and they were more likely to report the presence of multiple chronic diseases ranging from arthritis to previous heart attack to poor mental health. Although the finding that VA-only users are at elevated health risk was anticipated, our study now provides nationally representative estimates of the magnitude of these differences and reinforces the importance of accounting for them when making VA to non-VA comparisons.     

武警新兵1028名口腔健康调查报告

目的:了解驻粤某武警部队新兵的口腔健康情况,以便更好地开展口腔保健工作.方法:参考全国第二次口腔流行病学调查方法,调查驻粤某武警部队新兵1 028名,按兵源分为城镇组378名,乡村组650名.结果:调查结果显示驻粤某武警部队新兵的口腔常见病依次为:牙龈炎,牙石,龋齿,阻生齿,牙折,牙周炎,患龋率城镇组明显高于乡村组(P＜0.01),牙眼炎,牙石,阻生齿,牙折,牙周炎的患病率两组无明显差异(P＞0.05).结论:驻粤某武警部队新兵口腔卫生尚未达到要求,应建立官兵的口腔健康档案,加大重点人群的监控力度.     

Veterans' health and access to care in the year after September 11, 2001

OBJECTIVE: The goal was to explore veterans' perceptions of their health care in the year after September 11, 2001. METHODS: A random sample of outpatients seen at a Manhattan (New York City) or Midwestern Veterans Affairs facility between September 12, 2001, and September 30, 2002, received a mailed questionnaire. Regression assessed the effects of site, demographic features, military service, and symptoms of post-traumatic stress disorder (PTSD) on health status, care-seeking, and satisfaction with health care among 490 patients. RESULTS: Veterans from New York City reported better health and more satisfaction that their providers listened to them. Patients with more PTSD symptoms reported poorer health, more September 11-related symptoms, and less satisfaction with care and were more likely to seek care outside the Veterans Affairs system. CONCLUSIONS: Proximity to the September 11 terrorist attacks had little relationship to patients' perceptions of their health and health care, whereas PTSD symptoms had a pervasive effect. Patients with PTSD symptoms may require outreach programs to assist them in dealing with catastrophic events, regardless of their proximity to the events.     

Veterans' use of Department of Veterans Affairs care and perceptions of outsourcing inpatient care

The objective of the study was to examine veterans' perceptions of problems and benefits of outsourcing inpatient care from Veterans Affairs (VA) hospitals to private sector hospitals. Primary data were collected from a cross-section of 42 veterans who were VA users and nonusers using focus groups. Focus group discussion examined reasons patients use VA care, differences between VA and civilian care, positive and negative impacts of outsourcing, and special needs of veterans. Analyses revealed five domains related both to use of VA services and perceptions of outsourcing: costs, access, quality of care, contract (i.e., a covenant between veterans and the U.S. government), veteran milieu, and special needs. Participants identified a variety of potential positive and negative impacts. In general, veterans perceived more advantages than disadvantages to outsourcing VA care but still expressed significant concerns related to outsourcing. These issues should be considered in the development of future policy toward outsourcing VA care to the private sector.