Health Behavior, Problems With Access to Health Care
Conditions
Keywords
Veterans, Health Care Utilization, Rural Health, Patient Navigation, Motivational Interviewing
Brief summary
The purpose of the Alabama Veterans Rural Health Initiative is to better understand access and barriers to health care and to enhance veteran enrollment or engagement in health care services of veterans residing in rural areas. It describes an intervention that is adaptable for use by other VA facilities that serve veterans in rural settings, and importantly, this study will improve our understanding of barriers to care and evaluate a method for enhancing access to care. The anticipated impact is that more veterans in rural areas who were previously under-utilizing VA services will receive and attend a health care appointment. This gain may improve preventative and primary care health care and reduce long term health care morbidity, expense and burden. This study may also identify previously unknown barriers to care that can be surmounted by innovative access and health care delivery approaches. The primary objective is to evaluate an innovative approach for enhanced enrollment and engagement outreach intervention (EEE intervention) for rural veterans in VA health care services. This study entails a two-cell design, addressing this objective with a prospective, randomized controlled multi-site clinical trial that evaluates an active intervention compared to administrative outreach (AO, control condition) on whether or not a rurally-residing veteran obtains and attends a VA appointment.
Detailed description
Access, enrollment, and engagement with primary and specialty health care services present significant challenges for rural populations worldwide. The Alabama Veterans Rural Health Initiative evaluated an innovative outreach intervention combining motivational interviewing, patient navigation, and health services education to promote utilization of the United States Veterans Administration Healthcare System (VA) by veterans who live in rural locations.
Interventions
OTHEREnhanced Engagement and Enrollment (EEE)
Consists of motivational interviewing, educational outreach, and patient navigation.
OTHERAdministrative Outreach (AO)
Consists of giving information about enrolling for VA medical care or scheduling an appointment
Sponsors
Tuscaloosa Veterans Affairs Medical Center
VA Office of Research and Development
US Department of Veterans Affairs
Tuscaloosa Research & Education Advancement Corporation
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
NONE
Intervention model description
Prospective randomized control trial
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Veterans who live in rural Alabama counties who have either never enrolled or have previously enrolled but have not accessed a VA in 2 years or more * Signed informed consent * Any race, social class or ethnicity
Exclusion criteria
* Pending active legal charges or current/expected incarceration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Attendance at a VA Appointment | 6 months | Attendance at a VA appointment was derived from VA clinical records, defined as the participant attending a scheduled VA clinic appointment. Participants who did not attend a VA clinic appointment be the end of 6-month observation period were classified as censored at 6 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Days Until VA Clinic Appointment | 6 months | The number of days from day of randomization to day that the participant attended the VA clinic appointment (derived from the VA medical records). Participants who did not attend a VA clinic appointment be the end of 6-month observation period were classified as censored at 6 months. |
Countries
United States
Participant flow
Recruitment details
Rural veterans unlikely to be currently receiving VHA services were targeted for outreach, and therefore, recruitment design did not represent a population-based sampling strategy.
Participants by arm
| Arm | Count |
|---|---|
| Enhanced Enrollment and Engagement (EEE) The EEE intervention includes 1) an educational video about the services and mission of the VHA to mitigate possible negative beliefs about the VHA system of care; 2) a motivational interviewing component to address ambivalence and promote behavior change; and 3) a patient navigator model to help patients overcome systems barriers to enrolling and obtaining an initial appointment. | 101 |
| Administrative Outreach (AO) The Administrative Outreach includes a VHA enrollment document package without education, patient navigation, or motivational interview. The usual procedures for the VA to enroll the veteran were then followed by VA staff not associated with the research study. | 102 |
| Total | 203 |
Baseline characteristics
| Characteristic | Administrative Outreach (AO) | Total | Enhanced Enrollment and Engagement (EEE) |
|---|---|---|---|
| Age, Continuous | 55.39 years STANDARD_DEVIATION 14.6 | 55.6 years STANDARD_DEVIATION 14.4 | 55.72 years STANDARD_DEVIATION 14.24 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 34 Participants | 83 Participants | 49 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 67 Participants | 119 Participants | 52 Participants |
| Sex: Female, Male Female | 8 Participants | 14 Participants | 6 Participants |
| Sex: Female, Male Male | 94 Participants | 189 Participants | 95 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 101 | 0 / 102 |
| other Total, other adverse events | 0 / 101 | 0 / 102 |
| serious Total, serious adverse events | 1 / 101 | 2 / 102 |
Outcome results
Primary
Attendance at a VA Appointment
Attendance at a VA appointment was derived from VA clinical records, defined as the participant attending a scheduled VA clinic appointment. Participants who did not attend a VA clinic appointment be the end of 6-month observation period were classified as censored at 6 months.
Time frame: 6 months
Population: Consenting participants who were randomized and lived in rural location.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Enhanced Enrollment and Engagement(EEE) | Attendance at a VA Appointment | 88 participants |
| Administrative Outreach (AO) | Attendance at a VA Appointment | 59 participants |
p-value: <0.0001Chi-squared, Corrected
Secondary
Days Until VA Clinic Appointment
The number of days from day of randomization to day that the participant attended the VA clinic appointment (derived from the VA medical records). Participants who did not attend a VA clinic appointment be the end of 6-month observation period were classified as censored at 6 months.
Time frame: 6 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Enhanced Enrollment and Engagement(EEE) | Days Until VA Clinic Appointment | 12 days | Standard Deviation 49.8 |
| Administrative Outreach (AO) | Days Until VA Clinic Appointment | 98 days | Standard Deviation 93.1 |
p-value: <0.0001Log Rank