IRAQ WAR CLINICIAN GUIDE

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Iraq War Clinician Guide 100 Appendix C - IL 10-2004-001 February 6,2004 unique needs and status. Although Iraqi Freedom veterans are eligible for the Gulf War Registly, clinical registries only assess veterans on the one occasion when they volunleer for a soeciat examination. A much better a ~~mach is to ensure that all members of this unique . erouD - . ifveterans receive specialized care fk;n the time they first present to a VA Itealth care facility. e. Veterans of recent military conflicts are being asked specifically about chro~lic, debilitatina svmotoms because these com~laints were a maior health oroblem for some veterans afferthc laitkuif~arin 1991. a. Identifying Veterans for the Afghanistan and Iraq Clinical Reminder. Reminders are designed to apply to a given population and appear on a patient's CPRS screen, based on patient criteria found in a definable data field within CPRS. Oncc the Afghanistan and lraq clinical reminder soRwarc patch is installed and the remindcr is activated at a local facility, it will appear .. (pop-up) on thc CPRScover shect for veterans p-esenting to a VA health are facility who served in the Unitd States military ancr September 11.2001. when these dcploymcnts began. Identified veterans will then bz uked specifically whether they served on the ground, in nearby coastal waters, or in the air over Afghan~sthn and lraq ancr Septcmbcr l1.2001. If the veteran answcrs ycs, the rcst ofthe reminde~dialogue will appear on the computer screen for completion by the health care provider. I b. PreventingDuplication (I) Because of incrcdsingly widcsprcad use of electronic clinic31 reminders across VA. there is concern that continued ~mplemcntalion of new ren~inders will cause unduc burden to health care providers. To prevent duplication adunnecessxy work. a hcalth factor will bc available that allows this Afghanistm and lnq clinical reminder to br complctcd iust once in the lifctimc ofa vcteran. lmpo&ntly, the " ~f~lun 4lraq Post-Dcploymcnt ~crecn' will satisfy cumnt clinical reminders for depression, alcoliol abuse, and Post-tmum3tic Stress Disorder (PTSD) until thc schcdu.cd interval lapses for rc-adnii~iistrat~oi~ ol'these irmindcrs. Conscqacntly. vctcras w~llnor be asked thc same questions egain soon aflrr the completion of tl!is clinical r~nlindcr. (2) It \va not possible lo account for similar screening questions asked of veterans before this reminder conies into effect. However, this should be a rare problem because most veterans sent to lraq or Afghanistan will be young troops who usually have not received VA hcalth care. And for the veterans who have received VA hcalth care in the past, this will have occumd at least 6 to 12 months previously, which is the usual length ofdeploymeat to these theaters ol conflict. c. Resolving the "Afghan & lraq Post-Deployment Screen" (I) Oncea reminder pops-up on a computer screen in a VA health care facility, it needs to be resolved or will remain active. Reminders designate spccific tasks or evaluatio~is that need to be done or specific information that nccds to beprovided; and they designate what information. evaluation, or test results will turn off the reminder. Consequently, the reminder may trigger the I P DEPARTMENT OF VETERANS AFFAIRS - NATIONAL CENTER FOR PTSD
Iraq War Clinician Guide P 101 Appendix C - IL 10-2004-001 lrebruary 6,2004 ordering of additional tests. Alternately, informatio~i provided as a result of the reminder may be sufficient to resolvc it. This is the case for the Afgllanistan and lraq clinical reminder, which only involves specific screening questions. However, positive responses to these questions might direct the Ihealth care provider lo perform a more extensive clinical evaluation or, in some cases, to order additional diagnostic tests. (2) For the Afghanistan nnd lraq clinical reminder, all qucstions in thc reminder have to bc answered before it is resolved. The questions in this reminder address long-tern1 medical and psychological health risks among veterans of recent conflicts in Arghanistan and Iraq. Reminders are programmed so that when they are resolved, specific infonnation from Ule ~lninderis automatically downloaded into a progress note. d. Actitsation. The "Afghan & Iraq Post-Deployment Screen" was released on Ianuaty 26, 2004, and needs to be installed in CPRS VA-wide by the end of Februa~y 2004. This modification ofCPRS will enable VHA treatment facilities to reliably identify vetems ofthe recent conflicts in Afghanistan and lraqnnd provide targeted health care. e. Screening Questions. Veterans ofreccnt military conflictsare bcingaskcd spcciflcally about chronic, debilitating symptoms because thcse complaints were a major health problem for somevctcrans afler the last Gulf War in 1991. (1) The "Afghan &Iraq Post-Deployment Screen" begins with an inlroductoty explanation and screening question to confirm the veteran's status as a participant oithe recent conflicts in Southwest Asia (sce Att A). (2) The reminder then screcns for risk factors associated with the developmeiit of PTSD (see AH. B). (3) The reminder next screens for risk factors associated with the dcvclopment of dcprcssion (see Att. C). (4) The reminder next screens for risk factors associated with the developnlent ofalcohol abusc (scc An. D). (5) Finally, this clinical reminder scrrens for infectious diseases endemic to Soutl~west Asia and for chronic symptoms. This health problem is being fargeted in this clinical reminder because infectious diseases, principally cnteric infcctions, malaria, and leishmaniasis, can present afler a veteran rctums to the United States and even after separation from active duty. NOTE: More infortnation aborrl rcle~unr itfecliou diseases can be ohtaitlrd in tlrc VA Vetera~ts Hea/tl~ Iniliatil~e teaching tt~od~rle, "Et~deinic bfecIiulrs Diseases rfSnatlil~rst A.sia "fiu~d 01 l11111:/hv~t~w?va.~~~~~ul~iL . . -, .--- DEPARTMEhT OF VETERANS AFFAIRS - NATIONAL CENTER FOR PTSV
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