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Geographic Access and Use of Infectious Diseases Specialty and General Primary Care Services by Veterans With HIV Infection: Implications for Telehealth and Shared Care Programs

Authors

  • Michael E. Ohl MD, MSPH,

    Corresponding author
    1. VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City, Iowa
    2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VAMC, Iowa City, Iowa
    3. Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
    • For further information, contact: Michael Ohl, MD, MSPH, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Mailstop 152, Iowa City VAMC, Iowa City, IA 52246; e-mail: Michael.ohl@va.gov.

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  • Kelly Richardson PhD,

    1. VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City, Iowa
    2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VAMC, Iowa City, Iowa
    3. Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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  • Peter J. Kaboli MD, MS,

    1. VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City, Iowa
    2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VAMC, Iowa City, Iowa
    3. Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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  • Eli N. Perencevich MD, MS,

    1. VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City, Iowa
    2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VAMC, Iowa City, Iowa
    3. Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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  • Mary Vaughan-Sarrazin PhD

    1. VA Office of Rural Health (ORH), Veterans Rural Health Resource Center—Central Region, Iowa City, Iowa
    2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VAMC, Iowa City, Iowa
    3. Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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  • Disclosures: No authors have conflicts of interest relevant to this work.

  • Funding: The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region. Dr. Ohl is the recipient of a Career Development Award from the VA Health Services Research and Development (HSR&D) program. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

Abstract

Purpose

Rural-dwelling persons with HIV infection often have limited access to HIV specialty care, and they may instead use more nearby primary care. This study described use of infectious disease (ID) specialty and general primary care services among rural compared with urban veterans with HIV in the United States and determined associations between geographic access to ID and primary care and use of care.

Methods

The sample included all veterans in the national Veterans Administration (VA) HIV clinical case registry in 2009 (N = 23,669, 10.2% rural). Geographic access was measured by calculating travel times to the nearest VA primary care and ID specialty clinic.

Findings

Rural veterans were less likely than urban to use ID clinics (82% of rural vs 87% of urban, P < .01) and more likely to use primary care (82% vs 73%, P < .01). As travel time to ID care increased from less than 15 minutes to over 90 minutes, use of ID care decreased from 88% to 71% (P < .01), while use of primary care increased from 68% to 86% (P < .0001). In multivariable models, increased travel time to ID care—but not rural residence—was associated with decreased ID and increased primary care use.

Conclusions

Persons with HIV who live far from ID specialty clinics are less likely to use specialty care and more likely to use primary care. Specialty clinics should consider using telehealth to deliver care over distance and programs to coordinate “shared care” relationships with distant primary care providers.

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