Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol (1998) / Chapter Skim
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Findings and Recommendations
Findings and Recommendations
Pages 33-50
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From page 33... ...
It was for this system that an effort was undertaken to develop and implement a clinical diagnostic program that would identify the health problems of those who served in the Persian Gulf War and that could be implemented in each facility, regardless of its size. That effort was begun immediately upon the cessation of hostilities and drew upon lessons learned from past efforts to respond to the needs of Vietnam veterans.
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From page 34... ...
First, the committee provides its recommendation on the overall process to be used in a program focused on diagnosing Persian Gulf veterans' health problems. This is followed by specific recommendations regarding the elements of the process, its implementation and administration, and the quality of services rendered.
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From page 35... ...
1. The committee recommends that the diagnostic pathway, illustrated in Figure 5.1, for the evaluation and referral of Persian Gulf veterans' health be adopted and followed by providers in each VA facility.
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From page 36... ...
Pathway for diagnosing health problems of Persian Gulf veterans in the VA system.
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From page 37... ...
The pathway specifies an initial evaluation by a primary care provider for the Persian Gulf veteran. In traditional medical practice, the comprehensive clinical evaluation of a patient presenting to any physician includes a complete history, physical examination and laboratory tests appropriate to the presenting complaints or clinical problems.
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conduct periodic reevaluations of the usefulness of each element in the initial evaluation. Specific Gulf War-related questions to which veterans are asked to respond include the exposure questions contained on the Persian Gulf Registry Code Sheet (see Appendix H)
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From page 39... ...
Chapter 1 of VA Manual M-10, Part III identifies some special health needs of women veterans of the Persian Gulf including the long-term consequences of rape, other sexual assault, sexual harassment, exposure to combat during military service, or mistreatment as a prisoner of war. However, there is no specific reference to rape or abuse in the protocol history, and there is no routine evaluation of these activities in the absence of "reproductive health problems." Veterans have indicated that seeing others dead (including Iraqi soldiers)
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From page 40... ...
At the time of its development the VA protocol was an appropriate attempt to collect a wide variety of information that covered all known potential health concerns that could affect Persian Gulf veterans. Much has been learned since it was first implemented.
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From page 41... ...
3. The committee recommends that VA, to the extent possible, use an evidence-based approach to develop and continuously reevaluate clinical practice guidelines for the most common presenting symptoms and the difficult-to-diagnose, ill-defined, or medically unexplained conditions of Persian Gulf veterans.
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From page 42... ...
For the employed veteran, this can create additional difficulties related to missed work, missed pay, and poor employee evaluation. In addition, once specialty appointments are scheduled and the veterans are seen, the referral specialist is frequently unaware that the patient is a Persian Gulf veteran or the specialist has little or no experience with the particular needs and concerns of this group of patients.
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From page 43... ...
who will provide the consultative services to Persian Gulf veterans. Designated specialists should receive initial orientation concerning Persian Gulf War-related medical issues in their area of expertise.
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Quality There is a great deal of interest in learning more about the quality of care that Persian Gulf veterans are receiving in VA facilities. Although the committee believes that, overall, the clinicians involved in the VA Persian Gulf Registry and UCAP examinations are practicing medicine according to acceptable standards, there does not appear to be across facilities a systematic approach to documenting the quality of care provided to Persian Gulf veterans or to identifying areas where improvement is needed.
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From page 45... ...
VA has implemented a well-developed and structured approach for assessing general patient satisfaction with the care provided at VA facilities. However, no system specifically addressing the substantial numbers of issues and concerns specific and relevant to Persian Gulf veterans or the special Persian Gulf diagnostic program is in place.
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From page 46... ...
One explicitly stated purpose of the VA Persian Gulf Registry and UCAP is the creation of a registry that contains medical and other data on Persian Gulf veterans. This registry would assist in identifying previously unrecognized major diagnostic entities that could provide an explanation for the symptoms commonly reported in Persian Gulf veterans with unexplained illnesses (VA Manual M-10, Part III, Chapter 3, page 3-1~.
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From page 47... ...
Such variation hampers evaluation efforts based on these reported data. Until the national diagnostic pathway has been implemented, Phase I and Phase II eliminated, and the Code Sheet revised to reflect such changes, it is anticipated that this variation will continue.
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From page 48... ...
Such forms in general use throughout the VA system are not designed to easily identify Persian Gulf veterans. Although intake forms request dates of active-duty service, no questions specifically ask whether the veteran served in the Persian Gulf War.
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From page 49... ...
Although the designated Persian Gulf providers are given the opportunity to participate, other primary care personnel and specialists do not usually receive the materials nor do they participate in the educational programs. Some specialists appeared to know little about the VA Persian Gulf Registry and UCAP, had little or no orientation to the program, and were unable to identify whether the patients whom they saw were Persian Gulf veterans.
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From page 50... ...
A tremendous amount of knowledge about the diagnosis and treatment of Persian Gulf veterans' health problems is being amassed in various sites around the country. It behooves VA to identify where and with whom this special expertise exists and to develop mechanisms whereby others can benefit from the lessons that have been learned.
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