As we remember and honor our veterans on this Veteran’s Day 2018, America’s servicemen and women face unique challenges once their period of enlistment is over. The biggest challenge is most notably at the healthcare level. According to some vets and healthcare providers, the industry may not be keeping pace with the needs of veterans.
The State of Veteran Healthcare
Veterans are among some of America’s most underinsured, with more than 2 million without health insurance, reports ABC News. Nearly 4 million of their household members (typically spouses and children) also lack health insurance. Further, veterans commit suicide in disproportionate numbers when compared to the U.S. civilian population.
Despite those unfortunate statistics, the healthcare industry is making huge strides in order to better serve veterans of all ages. Technological advances, as well as an increased focus on veteran-specific mental health issues. are just a few of the industry-wide improvements that have been implemented in recent years.
Where the scope of veteran-specific healthcare improvement necessity is concerned, however, opinions vary widely. In a series of New York Times letters to the editor, some writers called the veteran healthcare system “creaky and unwieldy,” while others praised their local Veterans Administration (VA) hospital for consistently providing quality care over the long-term. “ I have been treated with respect, expertise, timely care, and medical professionalism ,” said one writer, an army veteran based in Washington. The same letter writer believes that providing accessible and affordable healthcare for all citizens, especially veterans, is the first step towards improving the U.S. healthcare system.
Veteran Healthcare Roadbumps
Veterans may face a variety of challenges when seeking care, from insurance hiccups to long wait times for VA care. One of the most glaring is access to care. “Access problems within the VA system may be creating disparities in care for this vulnerable and deserving population that need to be mitigated,” according to a study by Doohee Lee, Ph.D., and Charles Begley, Ph.D.
Lee and Begley looked at analytical data in order to determine if there was a correlation between delays in seeking healthcare and military veterans. They found that veterans were more likely to delay medical care than privately insured civilians. According to the study, one of the primary reasons for the delay in care is the lack of transportation. Nearly three out of 10 veterans report limited access to care.
Veterans, as well as low-income individuals on Medicaid and Medicare, sometimes have to travel a great distance in order to access a healthcare facility. Census data indicates that 25 percent of veterans live in rural areas. Some of those individuals must travel upwards of 100 miles to the nearest healthcare facility or VA hospital.
Some rural areas with a large veteran population introduced pilot programs aimed to solve the transportation access problem. For example, the Volunteers of America North Louisiana program provides a shuttle that transports veterans in rural areas to the closest VA hospital in Shreveport, Louisiana.
In the program’s first two years, it provided nearly 2,300 rides to veterans. This equated in a savings of $400,000 in out-of-pocket travel expenditures. The VA Office of Rural Health continues to advocate for greater facility access across the United States. Transportation access lives in the shadow of the most troublesome healthcare-related issue facing veterans, one that is also a major public health crisis: suicide.
Solving the Veteran Suicide Epidemic
Suicide is one of the leading causes of death in the U.S. Among individuals between the ages of 10-34. It is the second most common cause of death, behind only unintentional injury. Further, the National Institute of Mental Health reports that about 45,000 people commit suicide annually. When it comes to suicide, veterans are one of the most vulnerable groups.
According to the U.S. Dept of Veterans Affairs, veterans account for about 14 percent of suicides, despite making up only 8 percent of the U.S. population. The organization’s National Suicide Data Report, published in September 2018, found that veteran suicide rates increased by nearly 26 percent between 2005 and 2016. Firearms were used in a majority of veteran suicides. Seventy-one percent of male veteran suicide victims used a gun.
Healthcare professionals should be aware of the risk factors that contribute to the higher suicide rate in the veteran population. This includes sub-par mental health treatment. A comprehensive healthcare approach is needed in order to reduce veteran suicide rates. AI technology may be a key piece within a larger puzzle.
AI Technology and Veteran Healthcare
Due to the prevalence of digital channels in the healthcare industry, the data used to diagnose and treat patients has become increasingly easier to read. Diagnostics that are AI-driven may help streamline data collection as well as help practitioners predict health complications among their patients.
Some industry leaders even believe that an AI diagnostic approach may lead to improved veteran health and reduce the veteran suicide rate. After inputting patient data into an AI diagnostic machine, practitioners have more insights into the appropriate treatment. “AI-driven diagnostics sort through mountains of information to suggest possible conditions and treatment, deliver anesthesia, or assist professionals in medical procedures,” according to GCN.
It’s important to note that AI technology can’t replace the human side of healthcare. Even with the most advanced programming, AI diagnostics aren’t going to take individual patient needs such as drug tolerance, into account. AI technology must be used in tandem with exceptional, personalized treatment that targets specific conditions rather than symptoms.
Along with AI diagnostics, electronic health records (EHRs) are taking over the industry. EHRs eliminate the paper trail of documents the industry has relied on for decades. Electronic records replace bulky, wasteful medical files with digital information that can be accessed with a few clicks. Benefits of an EHR information system include the prevention of costly mistakes and the elimination of unnecessary procedures. EHRs may also reduce the chances of misdiagnosis and make healthcare more accessible for all patients, both veterans and civilians.
Further, EHRs go hand-in-hand with today’s preventative health and lifestyle apps. Data stored on these apps can be used to provide diagnostics and form treatment plans, especially for individuals with a pre-existing medical condition, such as PTSD.
Gender Disparity in Veteran-Based Healthcare
Veteran treatment may look different depending on whether a patient is male or female. Each gender has specific healthcare needs. Studies show that while male veterans are more likely to commit suicide, females run a higher risk of developing PTSD. While civilian females are twice as likely to develop PTSD than males, a PTSD diagnosis is a rarity among female veterans. The reason for the disorder diagnostic disparity between civilians and veterans is unclear. The disparity was attributed to transportation access or the lack of symptom reporting among female veterans.
It’s important for medical practitioners and other healthcare providers to understand how the role of women in the military has changed over the years. Since the Civil War, when the first female surgeon worked on a battlefield, females have moved from the sidelines to the front lines. During the Gulf War, the first female pilots took to the skies. It wasn’t until 2016 that women were permitted to engage in active combat.
Two years after the combat ban was lifted, there is still minimal research on the subject of female veterans healthcare. The inclusion of females in active combat equates to changing healthcare needs. PTSD is just one in a lengthy list of disorders seen in female veterans. The list also includes depression, alcohol abuse, anxiety, and other behavioral disorders.
Women continued to experience combat-related trauma. even though they were excluded from active combat for years, “While many women die or are seriously injured performing their duties, others become victims of stressors related to trauma exposure from combat and military sexual trauma (MST),” according to the National Center for Biotechnology Information.
Although PTSD is much more prevalent among females, research shows that female veterans are much less likely to report pain. The fact is that there are significantly more men than women in active combat roles. Additional research needs to be completed in order to fully understand how women and men differ in regards to military-related trauma.
In the wake of lifted combat restrictions, The National Center for PTSD expects to see the number of female veterans seeking mental healthcare services to increase over the next few years. As of 2016, about 8 percent of veterans are female. That number is projected to reach 11 percent of the total veteran population by 2020.
While mental health takes center stage in discussions of veteran medical service needs, reproductive health is an overlooked aspect of female-centric veteran healthcare. Female veterans may be more likely than civilians to have a high-risk pregnancy, especially if they have experienced PTSD or MST. The VA implemented its Women’s Health Services (WHS) department in 1988. The underlying goal of the WHS is to “ensure that all women veterans receive equitable, high-quality, and comprehensive healthcare in a sensitive and safe environment at all VA facilities.”
Women are the fastest-growing demographic within the VA community. That makes the WHS is more relevant than ever. Further, the department’s research and data collection is poised to play a key role in helping to develop a more comprehensive, veteran-centric healthcare model in the coming years.
Improvement Through Research Collaborations and EHRs
Research collaboration is imperative to the healthcare industry. The practice goes hand-in-hand with electronic health record (EHR) collection. Enacted in 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act provided incentives for providers who accelerated the adoption of EHR systems.
The aforementioned study by Drs. Lee and Begley is a great example of the type of research collaboration that can propel the industry forward. Their study also demonstrates the viability of EHRs as a research tool. Using EHR data, patient satisfaction surveys and census data, we can get a clearer picture of areas that need improvement. We also gain a better understanding of what works in the realm of veteran healthcare.
Despite gathering evidence that supports the VA’s findings on veteran healthcare access, According to Drs. Lee and Begley, there is still more work to be done in order to develop a comprehensive picture. “More studies are needed to expand our understanding on the magnitude and current status of care delay and offer specific steps to rectify related issues on delayed care if reported in military health care,” according to the pair.
Research collaboration has also changed over the years. Where once “collaboration” essentially referred to a mutually beneficial partnership between academic faculty members. Today collaborators can be an organization or government entity, such as the VA.
A prime example is the partnership between the VA’s WHS and the National Survey of Women Veterans (NSWV). A 20-year, WHS-funded study led by Dr. Donna Washington and her team at VA Greater Los Angeles looked at PTSD risk in female veterans. They also looked at whether there was any possible connection to VA healthcare attrition. The healthcare needs of women veterans are better understood thanks to the WHS and NSWV collaboration.
Electronic Health Records, Paranoia, and Patient Privacy
Despite the numerous benefits of EHRs, the electronic collection of data is far from infallible. The unique mental health needs of veterans means that healthcare practitioners need to have a clear understanding of EHR security.
One of the primary symptoms of PTSD is paranoia. Acute paranoia experienced by veterans can ultimately lead to major health complications, including suicide. The non-profit organization Operation: I.V. advocates for anxiety reduction therapy as a treatment method for veterans. The free sharing of information is part of their program. The Veteran Intervention Plan (VIP) program is designed to assist veterans who served in Iraq and Afghanistan. The program also encompasses job training, hyperbolic oxygen therapy, and service dogs on a case-by-case basis.
Practitioners can help alleviate the paranoia-based fears of veteran patients by allowing open discourse of the facility’s EHR risk management and data backup procedures. Protecting patient records is vital to the healing process, and paranoid veterans may need to see concrete proof that their data is being protected. Especially important if they find electronic data to be untrustworthy.
Data security is fundamental to the healthcare industry. It plays an unexpected role in the realm of veteran mental health. Understanding the unique healthcare needs of veterans is a step towards improving the industry as a whole. By integrating modern AI and electronic data collection with pharmaceutical-based PTSD treatment and gender-specific therapy, we gain a more comprehensive picture of veteran healthcare.
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