An Essential Guide to Chiropractic in the United States Military Health System and Veterans Health Administration

Abstract Introduction The United States Military Health System provides healthcare to a diverse patient population throughout the world. There are three distinct challenges that the Military Health System faces. (1) Providers have varying degrees of clinical training expertise and may be called upon to practice outside their usual scope of care. (2) There is geographic isolation of patients and providers with limited resources while stationed overseas. (3) Patients are at higher risk of breaks in continuity of care because of permanent change of duty stations, deployments, and retirement. Materials and Methods In this article we review the history of mobile health in both the civilian and military sectors, and how mobile health may be used to address the challenges unique to the United States Military Health System. Results There are many good initiatives in military mobile health, however they are decentralized and different across the services and military treatment facilities. We describe some military specific success stories with improving patient access to care and disease specific mobile health applications implemented. Conclusions Mobile health is a powerful platform which can help deliver standardized care in missions around the world and improve access to care for patients at military treatment facilities in the United States. The United States Military Health System would benefit greatly from creating universal mobile health applications to assist providers in patient access to care, military mission readiness, and disease specific modules. Future resources should be dedicated to the development of a mobile health application pool that is universally implemented across services to improve quality of care delivered at home and in theater by military providers.

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Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

BMC Health Services Research ◽

10.1186/s12913-021-06536-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rachel Sayko Adams ◽

Esther L. Meerwijk ◽

Mary Jo Larson ◽

Alex H. S. Harris

Keyword(s):

Mental Health ◽

Health Care ◽

Chronic Pain ◽

Veterans Health Administration ◽

First Year ◽

Veterans Health ◽

Health Administration ◽

Military Health System ◽

Military Health ◽

The Military

Abstract Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

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