ABSTRACT
Many American military personnel who served in the Iraq and Afghanistan wars will need long-term management of war-related conditions. There is pressing need for expertise in veterans’ care outside of the Military Health System (MHS) and Department of Veterans Affairs (VA), as many will seek care elsewhere: Veterans receive free MHS care only while on active duty; enhanced eligibility for VA healthcare ends 5 years after military discharge; many veterans eligible for VA healthcare use non-VA services instead; and the Affordable Care Act will expand Medicaid coverage for uninsured veterans. Families of veterans also may need care for conditions related to war service. Most medical schools lack veteran-focused curricula beyond VA clerkships, which often do not provide specific training on service-related conditions. The VA, Department of Defense (DoD), veterans groups, and medical professional organizations should partner to develop technical competencies in veteran and family health care for clinicians at all career stages, and cultural competencies to ensure contextually appropriate care. National and state licensing boards should assess these competencies formally. Partnerships between VA, DoD, and the community for care delivery can improve transitions and the quality of veterans’ post-deployment care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Data provided by the Defense Manpower Data Center, Department of Defense, 17 November 2011.
Spelman JF, Hunt SC, Seal KH, Burgo-Black AL. Post deployment care for returning combat veterans. J Gen Intern Med. 2012;27(9):1200–9. Epub 2012 May 31.
Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs Health Care, 2002–2008. Am J Public Health. 2009;99:1651–8.
Institute of Medicine. Returning home from Iraq and Afghanistan: preliminary assessment of readjustment needs of veterans, service members, and their families. Washington, DC: The National Academies Press; 2010. Available at: http://www.nap.edu/openbook.php?record_id=12812. Accessed January 16, 2013.
Office of the Surgeon General, United States Army Medical Command; Office of the Command Surgeon, Headquarters, United States Central Command; Office of the Command Surgeon, United States Forces Afghanistan. Joint Mental Health Advisory Team 7. Operation Enduring Freedom 2010. 22 February 2011. Available at: www.armymedicine.army.mil/reports/mhat/mhat_vii/J_MHAT_7.pdf. Accessed January 16, 2013.
Analysis of VA health care utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) Veterans: Cumulative from 1st Qtr FY 2002 through 3rd Qtr FY 2012 (October 1, 2001–June 30, 2012). September 2012. Epidemiology Program, Post-Deployment Health Group, Office of Public Health, Veterans Health Administration, Department of Veterans Affairs. Available at: http://www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2012-qtr3.pdf. Accessed January 16, 2013.
Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298:2141.
Mansfield AJ, Kaufman JS, Marshall SW, et al. Deployment and the use of mental health services among U.S. Army wives. N Engl J Med. 2010;362:101.
Gorman GH, Eide M, Hisle-Gorman E. Wartime military deployment and increased pediatric mental and behavioral health complaints. Pediatrics. 2010;126:1.
Data provided by the National Center for Veterans Analysis and Statistics, Department of Veterans Affairs, 9 January 2012.
Haley J, Kenney GM. Uninsured veteran and family members: who are they and where do they live? Timely Analysis of Immediate Health Policy Issues. The Urban Institute. May 2012. Available at: http://www.urban.org/UploadedPDF/412577-Uninsured-Veterans-and-Family-Members.pdf. Accessed January 16, 2013.
Schwartz A, Weiner SJ, Harris HB, Binns-Calvey A. An educational intervention for contextualizing patient care and medical students’ abilities to probe for contextual issues in simulated patients. JAMA. 2010;304:1191.
Association of American Medical Colleges. Serving those who serve America. 2012. Available at: https://members.aamc.org/eweb/upload/ServingThoseWhoServeAmerica.pdf. Accessed January 16, 2013.
Acknowledgements
The authors would like to thank Anita Navarro, Association of American Medical Colleges (AAMC), for her assistance in providing AAMC webinar data. This work was not funded.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Disclaimer
The views expressed are those of the authors and do not necessarily represent those of the Department of Defense or U.S. Department of Veterans Affairs.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chretien, JP., Chretien, K.C. Coming Home from War. J GEN INTERN MED 28, 953–956 (2013). https://doi.org/10.1007/s11606-013-2359-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-013-2359-7