PTSD disability examinations in the Department of Veterans Affairs: A comparison of telehealth and in-person exams
Abstract: It is estimated that the VA will have rendered decisions on roughly 1.4 million disability claims in 2021. A substantial percentage of these are for mental health conditions, specifically posttraumatic stress disorder (PTSD). Prior to the COVID-19 pandemic, almost all Compensation and Pension (C&P) examinations for PTSD were completed in-person; since March 2020, most have been conducted using telehealth. However, the content and quality of such exams, relative to those conducted in-person, have not been studied. The present study compared Initial PTSD examinations by telehealth to those completed in-person. Overall, 105 reports (51 in-person and 54 telehealth) were randomly selected from all Initial PTSD C&P exams completed within VA Connecticut between 2019 and 2020 (1 year preceding the pandemic and the first year of the pandemic). Raters were masked to all information indicating examiner, mode, and date of exam. Exam content was recorded, and exam quality was rated using three metrics that demonstrated adequate reliability and sensitivity in a prior study. There were no statistically significant differences between in-person and tele-exams on any relevant report content variables, report quality metrics, or VA disability rating outcomes. Results support the validity of the use of telehealth for conducting psychological exams for PTSD disability claims within the VA. Implications for the use of telehealth technology in improving operational breadth and reducing barriers to examination and care, both in the VA and beyond, are discussed.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.