Review examines optimal primary care for combat veterans

A new review by clinicians from the Veterans Administration (VA) outlines conditions common to returning combat veterans who served in Iraq and Afghanistan and provides management guidelines for optimal primary care.

The authors estimate that 1.44 million veterans of the Iraq and Afghanistan conflicts are currently eligible for VA services and that 772,000 have been cared for through the VA. Recent combat veterans are most prone to musculoskeletal problems, mental health conditions and “non-specific signs and symptoms,” the authors wrote. Combat and deployment come with risks including combat injury, occupational exposures, and chronic health problems, along with mental health and psychosocial risks.

Primary care clinicians caring for returning veterans need to be alert to managing musculoskeletal pain, sleep disturbances, post-traumatic stress disorder, and traumatic brain injury, the authors wrote. The experts compiled a list of “pearls” for clinical management of post-combat veterans, including the following:

• Address barriers to care.
• Establish a strong connection (acknowledge military service, take military history, and place this in a visible, easy to access part of the chart).
• Conduct a specialized review of systems, including combat exposures, blast exposures/concussive injuries, illness/injuries during deployments, tinnitus, dental concerns, chronic pain, sleep disturbance, tobacco, alcohol or substance abuse, depression screen, post-traumatic stress disorder screen and suicide assessment.
• Involve all members of the health care team; construct an easy-to-follow, well-sequenced and synthesized plan.
• De-stigmatize mental health care.
• Follow patients closely.
• Focus on function and reintegration.

The review, which also includes lists of online resources for clinicians and patients, was published by the Journal of General Internal Medicine and is available free of charge online.