Rural Native Veterans' Perceptions of Care in the Context of Navigator Program Development.

Introduction: American Indian and Alaska Natives serve in the military at one of the highest rates of all racial and ethnic groups. For Veterans, the already significant healthcare disparities Natives experience are aggravated by barriers to accessing care, care navigation, and coordination of health care within the Veterans Health Administration (VHA) between the VHA and tribal health systems. To mitigate these barriers, the VHA is developing a patient navigation program designed specifically for rural Native Veterans.

Tribal Perspectives on Patient Navigation for Rural Native Veterans Using Veteran Health Administration Services.

American Indian and Alaska Native (Native) Veterans enrolled in the U.S. Department of Veterans Affairs (VA) benefits program are far less likely to access health care compared to other racial/ethnic groups, in part driven by challenges posed by often distant, complex, and culturally unresponsive health care that does not easily interface with the Indian Health Service (IHS) and local Tribal Health Care.

Rural and Urban American Indian and Alaska Native Veteran Health Disparities: a Population-Based Study.

The health service ecology varies considerably across urban-rural divides for American Indian and Alaska Native (AIAN) veterans, which may place rural AIAN veterans at high risk for poor health outcomes. Using the Behavioral Risk Factor Surveillance System 2011 and 2012 data for its detailed race information, we employed adjusted multinomial logistical regression analyses to estimate differences in health outcomes among rural AIAN veterans (n = 1500) and urban AIAN veterans (n = 1567). We used rural White (n = 32,316) and urban White (n = 59,849) veteran samples as comparators.

Gender and posture are significant risk factors to musculoskeletal symptoms during touchscreen tablet computer use.

[Purpose] To investigate the prevalence of neck and shoulder symptoms during the use of tablet computer, and to identify the risk factors associated with these symptoms. [Subjects and Methods] A cross-sectional survey was conducted to study tablet computer usage, posture during use, and neck and shoulder symptoms in 412 participants in a school setting. Significant risk factors for musculoskeletal symptoms during tablet computer use were identified.

A Mindful Approach to Diabetes Self-Management Education and Support for Veterans.

Purpose The purpose of this study is to determine feasibility, satisfaction, and preliminary effects of Mindful Stress Reduction in Diabetes Education (Mind-STRIDE), a mindfulness-based intervention for veterans. Methods The study used a single-group pretest-posttest repeated-measures design. The 90-minute Mind-STRIDE training, adapted from Mindfulness Based Stress Reduction (MBSR), was provided as the final component of a half-day diabetes self-management education class at a Veterans Affairs (VA) outpatient diabetes clinic.

Rural American Indian and Alaska Native veterans' telemental health: A model of culturally centered care.

American Indian and Alaska Native (AI/AN) veterans living in rural areas have unique health care needs and face numerous barriers to accessing health care services. Among these needs is a disproportionate prevalence of posttraumatic stress disorder and other mental illnesses. Since 2001, 14 rural communities have partnered with the U.

Pharmacy Use in the First Year of the Veterans Choice Program: A Mixed-methods Evaluation.

Background: The Veterans Choice Program (VCP) was created to ensure timely access to health care in the Department of Veterans Affairs (VA). Under this program, medications may be ordered by select non-VA clinicians to be dispensed by VA pharmacies, creating new challenges in ensuring medication safety.

Objectives: To examine pharmaceutical use during the first year of the VCP and to understand barriers and facilitators for VA pharmacists to dispensing medications under the VCP.

Listening to the Patient: Women Veterans' Insights About Health Care Needs, Access, and Quality in Rural Areas.

Objectives: Many work to ensure that women veterans receive appropriate and timely health care, yet the needs of those living in rural areas are often ignored. This is a critical oversight given the multitude of reports documenting rural access problems and health disparities. Lacking this, we are unable to plan for and evaluate appropriate care for this specific group.

Lichenoid Reactions in Association with Tumor Necrosis Factor Alpha Inhibitors: A Review of the Literature and Addition of a Fourth Lichenoid Reaction.

In this manuscript, a clinical case of a patient treated with adalimumab for Behcet's disease develops lichen planopilaris. A variety of mucocutaneous lichenoid eruptions have recently been described in association with tumor necrosis factor alpha inhibitors. The authors briefly discuss the clinical and pathological presentation of lichen planopilaris as well as a potential pathogenesis of cutaneous adverse effects seen as the result of tumor necrosis factor alpha inhibitor therapy.

The impact of demographic differences on native veterans' outpatient service utilization.

Many Native veterans--including American Indian/Alaska Native (AIAN) and Native Hawaiian/Pacific Islanders (NHPI)--have served in the United States Armed Forces. Most of these veterans are eligible for medical care from the Department of Veterans Affairs (VA), but research examining the determinants of their service use is needed to inform policy and allocate appropriate resources for these unique groups. In a retrospective cohort study, we examined the impact of Native veterans' personal demographics on their outpatient utilization of VA-based primary care and mental health services.

Attitudes Toward Telemedicine in Urban, Rural, and Highly Rural Communities.

Introduction: The rate of telemedicine adoption using interactive video between patient and provider has not met expectations. Technology, regulations, and physician buy-in are cited reasons, but patient acceptance has not received much consideration. We examine attitudes regarding telemedicine to better understand the subjective definitions of its acceptability and utility that shape patients' willingness to use telemedicine.

Rural women veterans demographic report: defining VA users' health and health care access in rural areas.

Purpose: While many women choose to live in rural areas after retiring from active military duty, a paucity of studies examine rural women veterans' health care needs. This report is the first of its kind to describe the population demographics and health care utilization of rural female veteran patients enrolled in the Department of Veterans Affairs (VA).

Methods: Using the National Patient Care Datasets (n = 327,785), we ran adjusted regression analyses to examine service utilization between (1) urban and rural and (2) urban and highly rural women veterans.

Prevalence of and factors associated with subclinical posttraumatic stress symptoms and PTSD in urban and rural areas of Montana: a cross-sectional study.

Purpose: Posttraumatic stress disorder (PTSD) is an important clinical problem, but little is known about PTSD in rural, nonclinical populations. To better understand PTSD in rural areas, we examined the prevalence and risk and protective factors in urban, rural, and highly rural communities in Montana for both subclinical posttraumatic stress symptoms (PTSS) and PTSD.

Methods: We compared the prevalence of PTSS and PTSD in urban, rural, and highly rural communities in bivariate and multivariable regression analyses using self-reported cross-sectional survey data from the Montana Health Matters study (N = 3,512), a state-representative household-based survey done in 2010-2011.

Rural native veterans in the Veterans Health Administration: characteristics and service utilization patterns.

Purpose: The Department of Veterans Affairs (VA) and the Indian Health Service (IHS) signed a Memo of Understanding in 2010 to strengthen their partnership in improving health care services for Native veterans, who are disproportionately rural. This paper describes the demographic and service use profile of rural Native veterans who access VA health care.

Methods: Data were abstracted from the 2008 Veteran Health Administration (VHA) medical dataset, and the characteristics of rural Native veterans were compared to rural non-Native veterans.

Reaching rural communities with culturally appropriate care: a model for adapting remote monitoring to American Indian veterans with posttraumatic stress disorder.

Objective: Providing specialized healthcare to rural communities can be extremely difficult, and consequently many health organizations are turning to the use of telehealth technologies for care delivery. One such technology, remote monitoring, has been successfully implemented with patients suffering from chronic and other medical conditions. A drawback, however, is that remote monitoring devices are programmed to reach a broad audience, and consequently the content may not be suitable for all patients-especially those who are not a part of the dominant culture.

Predictors of attrition in older users of a home-based monitoring and health information delivery system.

Objective: This retrospective study evaluated predictors of attrition in data from veterans with chronic medical conditions who were enrolled in a Veterans Administration Care Coordination Home Telehealth program.

Subjects And Methods: Data were collected over a 4-year period. The enrolled sample was 73 veterans, 55.

Personal characteristics affecting veterans' use of services for posttraumatic stress disorder.

Objective: Posttraumatic stress disorder (PTSD) is widespread among veterans, but many veterans with PTSD use few health services. This study examined how individual characteristics influenced use of outpatient visits by veterans with PTSD.

Methods: The study assessed number of annual visits by 414,748 veterans with PTSD who sought care from October 2007 through September 2008 at U.

Characteristics of telemental health service use by American Indian veterans.

Objective: This study examined use by American Indian and Alaska Native veterans of services provided by specialty telemental health clinics focused on posttraumatic stress disorder. These clinics offer services via videoconferencing to address challenges faced by rural veterans in accessing care.

Methods: A retrospective chart and electronic medical record review was conducted for 85 male veterans who used services at two rural telemental health clinics from 2001 through 2006.

Review of American Indian veteran telemental health.

Rural American Indian veterans have unique healthcare needs and face numerous barriers to accessing healthcare services. Over the past decade, the Department of Veterans Affairs in conjunction with the University of Colorado Denver has turned to the promising field of telemental health to develop a series of videoconferencing-based clinics to reach this vulnerable population and improve mental healthcare services. The ongoing development, implementation, and expansion of these clinics have been assessed as part of a program improvement.

Characterizing "information transfer" by using a Joint Cognitive Systems model to improve continuity of care in the aged.

Purpose: This study explores multidisciplinary and cross-sector health professional experiences with the information needs for safe patient transfers across the care continuum using a Joint Cognitive Systems (JCS) model. Qualitative experiences of three JCS components and their attributes and are presented.

Methods: A qualitative content analysis using Joint Cognitive Systems constructs were extracted from sixteen multidisciplinary and cross-sector health professional interviews.

The diffusion of telehealth in rural American Indian communities: a retrospective survey of key stakeholders.

Objective: Mental health issues are a serious concern for many American Indian Veterans, especially for post-traumatic stress disorder and related psychiatric conditions. Yet, acquiring mental health treatment can be a challenge in Native communities where specialized services are largely unavailable. Consequently, telehealth is increasingly being suggested as a way to expand healthcare access on or near reservation lands.

A novel treatment for ulcerative calcinosis cutis.

Background: Calcinosis cutis is a term used to describe a group of disorders which result in calcium deposits in the skin. These disorders can be separated based on etiology.

Objective And Methods: Sodium thiosulfate has been used to systemically treat calciphylaxis with little to no adverse effects.

Pharmacist-managed telephone clinic review of antidementia medication effectiveness.

Objective: To describe the development and implementation of a telephone clinic for evaluating continued effectiveness of antidementia medication therapy in patients with dementia.

Setting: Ambulatory care at the Veterans Affairs Salt Lake City Health Care System.

Practice Description: A pharmacist-directed, telephone dementia clinic review of patients taking dual antidementia therapy to determine whether a medication-discontinuation trial is appropriate based on caregiver global impressions.