With over 9 million veterans relying on the U.S. Department of Veterans Affairs for healthcare, Federally Qualified Health Centers (FQHCs) play a crucial role in bridging the gap, providing accessible and comprehensive services to those who have served our country. I wrote this blog to shed light on the contributions of FQHCs in supporting veteran health, highlighting their unique approaches and the challenges they face in delivering care. During my Master’s Degree program in Public Health at Washington University in St. Louis, I had the invaluable opportunity to contribute to a groundbreaking research study in collaboration with the Department of Defense (DoD) and the Department of Veterans Affairs (VA). This project not only enriched my academic journey but also provided a deep dive into the critical intersection of military and veteran healthcare, showcasing the powerful impact of interdisciplinary partnerships in advancing public health initiatives.
Our study was one of the first to track the health-related quality of life (HRQoL) of military personnel from early recovery to two years post-combat injury. We found that while overall health scores improved over time, physical health (PCS) notably increased and mental health (MCS) experienced a slight decline. Veterans with spinal and traumatic brain injuries (TBI) had lower initial HRQoL scores, though physical health improved with time and limb amputation. Post-discharge infections were linked to worsening health scores. This research highlights the need for continued mental health support and effective infection management, while also providing insights into how specific injuries and interventions like amputation impact recovery.
The Department of Veterans Affairs (VA) is statutorily mandated to provide timely, comprehensive, and high-quality medical care to veterans, leveraging its position as the largest integrated healthcare delivery system in the nation. Despite the extensive network of VA health services, a significant concern remains about accessibility, particularly for the approximately 41% of VA-enrolled veterans living in rural or highly rural areas, who face unique challenges in obtaining healthcare. Rural veterans often experience higher rates of physical illnesses, reduced health-related quality of life, and increased overall healthcare needs compared to their urban counterparts. This disparity is exacerbated by logistical barriers such as long travel distances to healthcare facilities. As a result, rural veterans are less likely to engage with both VA and private sector health services.
In response to these access concerns, Congress has advocated for the VA to strengthen its collaborations with Federally Qualified Health Centers (FQHCs), which serve as crucial community-based resources for veterans. In 2023, over 400,000 veterans received care through FQHCs, highlighting their importance in expanding healthcare access for those in underserved areas.
Mental health challenges among veterans are particularly severe and often inadequately addressed. The unique stressors associated with military service, including deployment, combat, and military sexual trauma contribute to a range of mental health issues such as traumatic brain injury (TBI), PTSD, depression, anxiety, and substance use disorders. Veterans also face a notably higher risk of suicide, being 1.5 times more likely to die by suicide compared to the general civilian population. Studies indicate that 14 to 16% of U.S. service members deployed to Iraq and Afghanistan suffer from PTSD or depression, with one in five veterans from these conflicts experiencing significant mental health challenges. This underscores the urgent need for targeted mental health support and services.
Studies indicate that 14 to 16% of U.S. service members deployed to Iraq and Afghanistan suffer from PTSD or depression, with one in five veterans from these conflicts experiencing significant mental health challenges.
The health profile of veterans is concerning. Veterans not only suffer from obesity at higher rates than the general population, but also experience a range of associated co-morbidities such as coronary heart disease, stroke, cancer, chronic obstructive pulmonary disease (COPD), emphysema, arthritis, and diabetes. The interaction between depression, obesity, and diabetes further complicates their health outcomes, necessitating specific health screenings, preventive measures, and tailored healthcare services. The complex interplay of these factors highlights the need for specialized and comprehensive care to effectively address both physical and mental health issues for veterans.
Azara DRVS plays a pivotal role by helping to identify veterans, prioritize at-risk populations, and track their care journeys. This includes addressing both physical health metrics, such as hypertension control, and behavioral health concerns, like suicide risk assessment, depression and anxiety screenings, and medication management. Leveraging the Patient Visit Planning (PVP) report and alerts helps ensure timely interventions, flagging overdue screenings like PHQ-9 or alcohol assessments. ‘Veteran’ is also an SDOH trigger that can identify patients on the PVP.
Registries offer extensive data elements to monitor conditions such as PTSD or depression and track recent behavioral health evaluations (PHQ-9, GAD-7, SBIRT). Combining these resources allows for refined targeting of veteran care, considering factors like social drivers of health (SDOH), homelessness, and various diagnoses identified through filters. Veteran status can also be specifically identified utilizing filters.
Addressing both mental health and physical conditions is essential for veterans' successful reintegration and life satisfaction. My research indicates that many engaged veterans receive consistent care through the Department of Veterans Affairs, accessing a variety of services and specialists.
As we pause this coming Veterans Day to reflect on the sacrifices made by those who have served our country, it’s crucial to also confront a pressing issue that often goes unnoticed: the inequities in healthcare access for veterans. While we honor their bravery and commitment, we must also advocate for a system that ensures every veteran receives the quality care they deserve, regardless of where they live or their socioeconomic status. This reflection should inspire us not only to express gratitude but to actively address the disparities that hinder the well-being of our heroes.
By fostering collaboration with community-based providers, such as FQHCs, and focusing on integrated care, we can significantly improve the well-being of this population of heroes.
