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