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VA Health Care: Better Integration of Services Could Improve Gulf War Veterans' Care

HEHS-98-197 Published: Aug 19, 1998. Publicly Released: Aug 19, 1998.
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Highlights

Pursuant to a congressional request, GAO provided information on the Department of Veterans Affairs' (VA) provision of health care services to Gulf War veterans, focusing on: (1) the number of veterans VA and the Department of Defense (DOD) report as suffering from Gulf War-related illnesses and the criteria used to identify these illnesses; (2) how VA diagnoses, counsels, treats, and monitors Gulf War veterans for the health problems they report; and (3) Gulf War veterans' satisfaction with the health care they receive from VA.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of diagnoses of illnesses.
Closed – Implemented
The DOD/VA Post-Deployment Health Evaluation and Management Clinical Practice Guideline was completed in September 2001. The guideline is meant to assist clinicians in primary care settings in determining specific diagnoses for individuals seeking care for potentially deployment related experiences or exposures. A main guideline objective is to improve local management of patients with post-deployment health concerns and thereby improve patient outcome. The Post-Deployment Health Evaluation and Management Clinical Practice Guideline is available through VA's Office of Quality and Performance (Publication No. 10Q-CPG/PDH-01) or VA's internet web site, http://www.oqp.med.va.gov/cpg/PDH/G/PDH_about.htm.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of treatment of symptoms and illnesses.
Closed – Implemented
In March 2002, VA completed work on a significantly updated and revised CME program. The course "A Guide to Gulf War Veterans' Health" represents a complete revision of the independent study released in March 1998. This revised Gulf War independent study module was created as a part of the Veterans Health Initiative (VHI). The VHI is a comprehensive program of continuing education that recognizes the connection between certain health effects and military service, and emphasizes better military medical histories for veteran patients in order to provide them with the best available care. The revised independent study provides an overview of the Gulf War experience, the VA and DoD health programs available for Gulf War veterans, and the common symptoms and diagnoses of these veterans. VHA believes that Gulf War (GW) veterans can receive appropriate care in a variety of settings if the health care providers are adequately informed about their special health concerns. VHA Directive 98-018 defines the requirement that VA physicians complete the independent study, which synthesizes much information on the Gulf War and VA's programs for GW veterans as well as peer-reviewed scientific articles. A mechanism was established to track and test health care providers who completed the self-study material for CME credits.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of evaluation of treatment effectiveness.
Closed – Implemented
The Demonstration Projects for Treatment of Gulf War Veterans' Illnesses are now completed. The final reports, as well as summaries, are available on the internet at http://www.va.gov/health/environ/persgulf.htm. In May 2001, two War-Related Illnesses and Injury Study Centers (WRIISC) were established to find effective prevention and treatment for veterans with difficult to diagnose yet debilitating health problems. The WRIISCs are located at the VA medical centers in Washington, D.C., and East Orange, New Jersey. The WRIISCs are responding to the health problems of veterans by improving the care of active duty and veteran patients with war-related illnesses. Additionally, VA and DoD have developed a collaborative Clinical Practice Guideline "Medically Unexplained Symptoms: Chronic Pain and Fatigue." The guideline was developed to assist VA and DoD clinicians responsible for the assessment and care of patients with medically unexplained symptoms of chronic pain and fatigue. The guideline was presented during a live, interactive satellite broadcast on June 27, 2002. The satellite program discussed historical context, key elements, evidence-based assessment and treatment, risk management strategies, and support tools. Final guideline approval is expected in September 2002. A preview draft version is available on the U.S. Army MEDCOM internet site http://www.cs.amedd.army.mil/qmo/mus/guideline.doc.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Under Secretary for Health to uniformly implement a health care process for Gulf War veterans that provides for the coordination of periodic reevaluation of those veterans whose illnesses remain undiagnosed.
Closed – Implemented
We recommended that the Secretary of Veterans Affairs implement a health care process for Gulf War veterans that provides for the coordination of periodic reevaluation of those veterans whose illnesses remain undiagnosed. VA and DoD have developed a collaborative Clinical Practice Guideline Medically Unexplained Symptoms: Chronic Pain and Fatigue. The guideline was developed to assist VA and DoD clinicians responsible for the assessment and care of patients with medically unexplained symptoms of chronic pain and fatigue. The guideline was presented during a live, interactive satellite broadcast on 6/27/02. The satellite program discussed historical context, key elements, evidence-based assessment and treatment, risk management strategies, and support tools. Final guideline approval is expected in September 2002. A preview draft version is available on the U.S. Army MEDCOM internet site http://www.cs.amedd.army.mil/qmo/mus/guideline.doc.

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Topics

Armed forces abroadBiological warfareDisease detection or diagnosisGulf war syndromeHealth care servicesHealth hazardsHealth services administrationMedical examinationsMilitary personnelSurveysVeterans hospitalsGulf War registry