Rural Health

Spotlight on VA Research

Nearly 40 percent of Veterans who rely on VA for their health care live in rural areas. Over the past 10 to 15 years, VA has launched several initiatives to expand and ensure access to high-quality health care for these Veterans. VA researchers have been instrumental in these efforts by developing and evaluating new technologies, interventions, and models of care. VA uses a three-pronged strategy to meet the needs of rural Veterans:

• Providing additional sites for care
• Using new technologies
• Partnering with non-VA providers

VA researchers have played a critical role in each of these areas.

Providing additional sites for care

Since the mid-1990s, the VA health care system has expanded geographically to include hundreds of Community Based Outpatient Clinics (CBOCs) where Veterans can access primary care and other services. About half of these clinics are in rural areas. VA has also expanded the use of home-based primary care to serve Veterans who live in rural areas, as well as those who are homebound because of illness, disability, or frailty.

Examples of research in this area include the following:

• In a database study that included more than 63,000 patients, VA researchers confirmed that CBOCs improve access to primary care and other services in a cost-effective manner.
• VA researchers surveyed nurse managers in 46 primary care clinics—half at VA medical centers and half at CBOCs—to identify any gaps in mental health services. The survey found that integration of care and services overall was comparable between the two types of clinics.

Using new technologies

In the past decade, VA has developed a robust telehealth program that uses technologies such as the telephone, Internet, videoconferencing, email, text messaging, and digital photography to expand health services for Veterans in rural areas. These efforts have been guided by studies such as these:

• VA researchers reported on the effectiveness of a program in which Veterans with diabetes undergo specialized imaging of their retinas during eye exams at local VA clinics, and the images are sent electronically to off-site experts who check for signs of diabetes-related retinal disease.
• A VA research team found that small rural clinics without on-site psychiatrists could successfully adapt a team model of depression care—shown effective in larger VA settings—by using telemedicine technologies such as the telephone and videoconferencing.

Partnering with non-VA providers

Through contracts and partnerships with community-based providers and agencies such as the Indian Health Service (IHS), VA is able to expand its network of services for Veterans living in remote areas. These collaborative efforts address needs in areas such as primary care, mental health care, long-term care, and hospice care.

Examples of research projects in this area include:

• A VA study examined patterns of health care usage among Veterans eligible for care from both VA and the IHS. The researchers documented barriers to care—such as distances between VA and IHS facilities—and made specific recommendations for addressing these issues and boosting information-sharing between the two federal agencies.
• VA investigators are studying the feasibility of implementing telemedicine-based depression care in small rural Community Based Outpatient Clinics (CBOCs) managed by community-based providers under contract with VA.

Ensuring Access for OEF/OIF Veterans

According to the National Rural Health Association, more than 40 percent of Veterans returning from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are from rural areas. Many of these Veterans are coping with issues such as PTSD or traumatic brain injury. VA researchers are studying the particular health care challenges of these Veterans and working to develop solutions to meet their needs. Here are two examples of current studies:

A study titled "Geographic Access to VHA Rehabilitation Services for OEF/OIF Veterans" is tracking a group of 8,000 to 10,000 Veterans who suffered traumatic injuries to identify what types of VA services they are receiving and to explore issues that may be affecting their access to care. In a project titled "Telephone-Based Care for OEF/OIF Veterans with PTSD," VA researchers are examining the effectiveness of telephone-based counseling as an adjunct to standard care for PTSD.

Exploring New Technology

VA researchers have led the way in exploring the use of telehealth—health care provided through means such as the telephone, Internet, videoconferencing, email, and text messaging—to promote more timely and effective health care for Veterans. These technologies are particularly important for Veterans in rural areas, but they have also come to play a role in the delivery of efficient, high-quality health care for other Veterans as well—such as those who are homebound because of illness or disability.

Researchers at the Portland (Ore.) VA Medical Center compared text-enabled cell phones to more conventional means—phone, fax, or email—as a way for Veterans to send their home-based blood-pressure readings to VA clinics. Veterans who used text messaging achieved their blood-pressure goals an average of two weeks sooner than those who used other methods.

A research team with the Pacific Island Division of VA's National Center for PTSD found that videoconferencing could be an effective means to provide coping skills for Veterans in rural areas who are affected by PTSD.

Investigators with the Defense and Veterans Brain Injury Center (a collaborative project between the Department of Defense and VA) are exploring the use of interactive Web-based systems to enhance medical and rehabilitative care, social support, and vocational training for Veterans in rural areas who are recovering from traumatic brain injuries.