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Background: Direct acting oral anticoagulants (DOACs) theoretically could contribute to addressing underuse of anticoagulation in non-valvular atrial fibrillation (NVAF). Few studies have examined this prospect, however. The potential of DOACs to address underuse of anticoagulation in NVAF could be magnified within a healthcare system that sharply limits patients' exposure to out-of-pocket copayments, such as the Veterans Health Administration (VA). Methods and Results: We used a clinical data set of all patients with NVAF treated within VA from 2007 to 2016 (n=987 373). We examined how the proportion of patients receiving any anticoagulation, and which agent was prescribed, changed over time. When first approved for VA use in 2011, DOACs constituted a tiny proportion of all prescriptions for anticoagulants (2%); by 2016, this proportion had increased to 45% of all prescriptions and 67% of new prescriptions. Patient characteristics associated with receiving a DOAC, rather than warfarin, included white race, better kidney function, fewer comorbid conditions overall, and no history of stroke or bleeding. In 2007, before the introduction of DOACs, 56% of VA patients with NVAF were receiving anticoagulation; this dipped to 44% in 2012 just after the introduction of DOACs and had risen back to 51% by 2016. Conclusions: These results do not suggest that the availability of DOACs has led to an increased proportion of patients with NVAF receiving anticoagulation, even in the context of a healthcare system that sharply limits patients' exposure to out-of-pocket copayments.

OBJECTIVES: There are currently no reliable estimates of the prevalence of gastrointestinal disease in the US Military Veterans. Hence, the study aims to determine its prevalence in military Veterans in the United States. METHODS: This study utilized a retrospective, correlational design using a patient record database from the Department of Veteran's Affairs. The participants in the study were Veterans diagnosed with gastrointestinal disease. Specific gastrointestinal diseases include more than 500,000 ambulatory care visits annually in the United States, which included peptic ulcer disease, gastroesophageal reflux disease, diverticular disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome, and functional dyspepsia, as well as the symptoms of constipation and nausea/vomiting. This study revealed the exact prevalence of gastrointestinal disease diagnosed in Veterans served in outpatient settings by the Veterans Health Administration and broke down this prevalence over time and by the Veteran period of service. RESULTS: Findings revealed that gastrointestinal disease prevalence among Veterans varied according to their period of service. CONCLUSIONS: Findings may help improve screening for Veterans with this increased risk factor. However, further research should be performed to verify the prevalence of gastrointestinal disease in Veterans as compared to the general American population.

The digital divide's implications on health inequality among American Military veterans has been discussed extensively in research; however, it remains unclear what is the association between Internet usage and health specifically among Veterans. We examine this question by addressing the growing digital gaps in the veteran population, looking at the association of Internet use and self-reported health. Using the National Survey of Veterans we find that compared to those who use the Internet daily, those who use the Internet less frequently have significantly higher odds of reporting "fair" or "poor" self-rated health. The significant association remained when demographic, socioeconomic, and military factors were controlled. While our results indicate that veterans that use the Internet more frequently report more favorable self-reported health, given our data we are unable to distinguish a causal relationship. We conclude by discussing potential policy interventions, targeting helping those who are left behind.

Purpose. National smoking cessation practice guidelines offer recommendations regarding the processes and structure of care. Facilities routinely measure the processes of care but not the structure of care. This pilot study assessed the structure of smoking cessation care at Veterans Health Administration facilities. Methods. Key informants at 18 sites completed a brief checklist survey adapted from national smoking cessation guidelines. Responses were compared with detailed site surveys. Results. Guideline adherence was seen in identifying smokers and treating inpatient smokers. Areas of low adherence include offering incentives and defining staff responsibilities. The checklist survey showed poor correspondence with the detailed survey, with low agreement on systematic screening (kappa = .21) and higher agreement on primary care prescribing authority (kappa = .53). Discussion. This pilot survey provides a potential rapid method for assessing adherence to systems recommendations from the national smoking cessation guidelines. The relatively low agreement with a more detailed survey suggests that the two surveys may have been measuring different aspects of smoking cessation care.

A democratic deliberation panel of veterans providing insight into veteran perspectives on resource allocation and the Veterans Choice Act showed the importance and feasibility of engaging veterans in the policy-making process.

Shipping list no.: 91-759-P. ; "G-1." ; Cover title. ; Includes bibliographical references (p. 12-14). ; Mode of access: Internet.

This research brief describes the use of acupuncture as a mechanism for the development of crossagency knowledge translation and evidence-based practices in order to ensure the best possible care for the nation's veterans.

A compilation of research presented at the 2nd Military and Veteran Health Research Forum, sponsored by the Canadian Institute for Military and Veteran Health Research, and hosted by Queen's University and the Royal Military College of Canada, Nov. 2011--Acknowledgments

A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO reviewed information system general controls over financial and sensitive veteran medical information maintained by the Veterans Health Administration (VHA), focusing on: (1) specific computer security weaknesses GAO identified at the New Mexico and North Texas health care systems in conjunction with the audit of the Department of Veterans Affairs (VA) fiscal year (FY) 1997 financial statements; and (2) departmentwide computer security initiatives that GAO reported in October 1999."

OBJECTIVE: The purpose of this article is to provide an essential overview of chiropractic services in United States military and veterans' health care systems. METHODS: We reviewed literature, legislation, and policies from 1936 through September 2021 pertaining to chiropractic services in the United States military and veterans' health systems. Using these sources and our combined experience in these systems, we identified fundamental themes in the delivery of chiropractic care in the health care systems of the Department of Defense (providing health care for active duty service members) and the Department of Veterans Affairs (providing health care for veterans) in main topic areas. RESULTS: We identified 7 main topic areas relevant to the 2 systems: populations served by chiropractors; health care systems; integration; utilization and supply of chiropractic care; vetting of chiropractors; roles and evaluation of chiropractors; and oversight and leadership. Key information about chiropractic care in these systems was synthesized into the main topic areas. Benefits of high-quality within-system chiropractic care to active-duty service members and veterans are presented. The assets that within-system chiropractors bring to the Department of Defense and Department of Veterans Affairs health care systems are discussed for each main topic area. CONCLUSION: This article contains an essential overview of chiropractic services in the Department of Defense and the Department of Veterans Affairs. It offers clarity regarding the integration of chiropractic services into these health care systems and includes a 1-page brief of talking points that may help better inform ongoing discussions of chiropractic services in these 2 different but intertwined environments.