Alabama Veterans Rural Health Initiative: A Pilot Study of Enhanced Community Outreach in Rural Areas

Authors

  • Michelle M. Hilgeman PhD,

    Corresponding author
    1. Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
    2. Tuscaloosa Research & Education Advancement Corporation, Tuscaloosa, Alabama
    3. Center for Mental Health and Aging, The University of Alabama, Tuscaloosa, Alabama
    • For further information, contact: Michelle M. Hilgeman, PhD; Research & Development Service, Tuscaloosa VA Medical Center, 3701 Loop Road, Tuscaloosa, AL 35404; e-mail: Michelle.Hilgeman@va.gov.

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  • Ann F. Mahaney-Price DNP,

    1. Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
    2. Tuscaloosa Research & Education Advancement Corporation, Tuscaloosa, Alabama
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  • Marietta P. Stanton PhD, RN,

    1. College of Nursing, The University of Alabama, Tuscaloosa, Alabama
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  • Sandre F. McNeal MPH,

    1. Center for Surgical, Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama
    2. Department of Surgery, Section of GI Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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  • Kristin M. Pettey MSW,

    1. VA Southeast Veterans Integrated Service Network (VISN) 7 Office, Department of Veterans Affairs, Tuscaloosa, Alabama
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  • Kroshona D. Tabb PhD,

    1. Center for Surgical, Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama
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  • Mark S. Litaker PhD,

    1. Department of Clinical and Community Sciences, Division of Behavioral and Population Sciences, University of Alabama at Birmingham, Birmingham, Alabama
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  • Patricia Parmelee PhD,

    1. Center for Mental Health and Aging, The University of Alabama, Tuscaloosa, Alabama
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  • Karl Hamner PhD,

    1. College of Nursing, The University of Alabama, Tuscaloosa, Alabama
    2. School of Social Work, The University of Alabama, Tuscaloosa, Alabama
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  • Michelle Y. Martin PhD,

    1. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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  • Mary T. Hawn MD,

    1. Center for Surgical, Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama
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  • Stefan G. Kertesz MD,

    1. Center for Surgical, Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, Alabama
    2. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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  • Lori L. Davis MD,

    1. Research & Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
    2. Tuscaloosa Research & Education Advancement Corporation, Tuscaloosa, Alabama
    3. Department of Psychiatry and Behavioral Medicine, The University of Alabama School of Medicine, Birmingham, Alabama
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  • the Alabama Veterans Rural Health Initiative (AVRHI) Steering Committee


  • All AVRHI Collaborators are listed in the Online Appendix.

  • Funding: The VA Office of Rural Health funded staff salaries and provided resources for the outreach activities described in this study; however, the sponsor did not have a role in study design, collection, analysis, interpretation of data, preparation of this report, or the decision to submit the paper for publication.

  • Disclosures: During the past 12 months Lori Davis, MD, received research funding from AstraZeneca and Merck, and consulting fees from Eli Lilly and Bracket Global.

  • Acknowledgments: We are grateful for the support of the VA Office of Rural Health (funding), Lawrence Biro, EdD (former VA VISN 7 Director), Alan Tyler, MS, MPA, FACHE (former Tuscaloosa VA Medical Center Director), Rica Lewis-Payton, MHA, FACHE, (former Birmingham VA Medical Center Director), and VA Research Services at the Tuscaloosa and Birmingham VA Medical Centers. A full list of participating Alabama Veteran Rural Health Initiative (AVRHI) investigators and institutions are listed in the Online Appendix.

Abstract

Purpose

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.

Methods

Community outreach workers completed the intervention and assessment, enrolling veterans from 31 counties in a southern state. A total 203 participants were randomized to either an enhanced enrollment and engagement outreach condition (EEE, n = 101) or an administrative outreach (AO, n = 102) condition.

Findings

EEE participants enrolled and attended VA appointments at higher rates and within fewer days than those who received AO. Eighty-seven percent of EEE veterans attended an appointment within 6 months, compared to 58% of AO veterans (P < .0001). The median time to first appointment was 12 days for the EEE group and 98 days for the AO group (P < .0001). Additionally, a race by outreach group interaction emerged: black and white individuals benefited equally from the EEE intervention; however, black individuals who received AO took significantly longer to attend appointments than their white counterparts.

Conclusions

Results provide needed empirical support for a specific outreach intervention that speeds enrollment and engagement for rural individuals in VA services. Planned interventions to improve service utilization should ameliorate ambivalence about accessing health care in addition to addressing traditional systems or environmental-level barriers.

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