Health in the military

Keeping the military Healthy

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Publication: ADVANCE for Nurses Online Issue Date: 1/7/2002 Search String: gagliardi

Vol. 4 •Issue 1 • Page 21

Keeping the military Healthy Program for reservists helps identify health risk factors and keeps them ready to deploy at a moment's notice

By Claudia Stahl Gagliardi

Like so many in the general population, some of the 550,000 troops in the Army Reserve and National Guard have hypertension and high cholesterol levels. These conditions can impact reservists' readiness to serve in a conflict.

Compounding the problem, 25 percent of reservists do not have health insurance. But the Army Reserve and Guard require soldiers under age 40 to have a physical examination every 5 years; those over age 40, every 3 years. Between physicals, reservists sign an annual medical and dental certification attesting that their health and dental status has not changed within the year, or since their last physical exam.

This document implies that the soldier is healthy enough, or "medically ready," to be deployed to a mission at any given moment.

However, with the advent of downsizing, there are no longer enough medical personnel or medical facilities in the military to sign off on every health certification, or to provide physicals to every reservist. Thus, the Federal Strategic Health Alliance (FEDS_HEAL) program was initiated. FEDS_HEAL enables the Army Reserve to combine the resources of the Veterans Health Administration (VHA), which, with 173 VA facilities nationally, is the second-largest health care system in the United States; the U.S. military and the federal occupational health component of the U.S. Department of Health and Human Services.

Through the program, reservists come to the VA on weekends for their physicals and health assessments.

This combination of federal health agencies allows access to health evaluation services for more than 99 percent of Army reservists. There is no shortage of VA facilities around the country, so access to care is not an issue, and there is an ample supply of medical professionals to perform the exams.

The ultimate goal of the program is to identify health risk factors before they become full-blown diseases. Simply put, the military trains soldiers to dodge bullets, bombs and biological weapons; the VA trains them to dodge cigarettes, alcohol and fatty foods.

HEALTH PROMOTION Following the 1999 pilot program initiated in four Veterans Integrated Service Networks (VISNs), Maj. Gen. Marianne Mathewson-Chapman, PhD, ARNP, was selected to direct one of the country's first FEDS_HEAL programs at VISN 8. This network of seven VA medical centers provides services to more than 29,000 Army Reserve and National Guard soldiers in Florida and Puerto Rico combined. Health promotion is the core of the program, explained Dr. Mathewson-Chapman, who oversees the medical readiness mission for Army Reserve component soldiers.

Previous health evaluation programs have neither addressed the impact of chronic medical conditions on

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Keeping the military Healthy

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the force, nor the importance of developing self-care strategies to manage these conditions and ensure medical readiness. Noting that chronic conditions begin to manifest after age 40, Dr. MathewsonChapman reported that up to 28 percent of the force in the Army Reserve and National Guard has passed its fourth decade. An estimated 37-42 percent of the Air National Guard and Air Force Reserve, and 32 percent of the Navy, is over age 40. By contrast, only 9-13 percent of the active duty force is older than 40.

According to Dr. Mathewson-Chapman, the FEDS_HEAL program increases morale among reservists, as well as the VA staff. The nurses are enthusiastic about treating a younger population, and the soldiers have reported receiving "the best physical of their lives." The nursing staff at VISN 8 in Puerto Rico even adopted camouflage pants and black golf shirts as their weekend uniform, so they will look representative of the military.

CHRONIC CONDITIONS Many soldiers have been evaluated for hypertension, high cholesterol and other chronic ailments under FEDS_HEAL. Eligible soldiers are referred to the VHA for follow-up care; untreated, these reservists would not be considered medically ready for deployment. Soldiers must have 90 days worth of medication to be eligible for deployment, and medical conditions, such as hypertension, must be under control with medication and a medical treatment plan. Pregnancy and some dental conditions are also disqualifying factors for military readiness.

Reservists over age 40 receive a comprehensive exam that includes blood work, ECG, a glaucoma check and a total lipid profile. Men receive a prostate check and PSA blood evaluation, and women, a pap smear. Dr. Mathewson-Chapman said the program could begin to perform total lipid profiles beginning at age 30, as more soldiers within that age bracket are being diagnosed with high cholesterol.

Education in self-care strategies is an important component of the program. Videos on various conditions and a patient care library are available for reference, but health care providers also educate patients on their medical conditions and behavior modification.

The military has already made great strides in alcohol control, "not so much because of preventive programs, but because if you're caught with a DWI while on active duty, your career is over," said Dr. Mathewson-Chapman. She is hoping for similar measures for smoking, "which interferes with your night vision, with your accuracy in shooting a weapon, circulation conditions and wound healing. Someday, we need to become a smokeless military."

TRACKING OUTCOMES Teaming with the U.S. Army Center for Health Promotion and Preventive Medicine, the program will begin to track health outcomes on an annual basis. Soldiers will complete a Web-based health status survey, and the data will be stored and analyzed to identify risk indicators.

"We will track everything from diet to mental health, which we have not been able to track in the past," said Dr. Mathewson-Chapman.

If a health risk is identified (e.g., hypertension), the soldier will be referred to a health care provider for an assessment, and also to a Web-based correspondence course on the condition. Eventually, the tracking system will yield a comprehensive picture of the overall health of the Army Reserve and National Guard, and possibly other branches of the military.

A medical board determines whether a soldier is no longer deployable. Asthma and conditions that necessitate a strict diet (e.g., diabetes) or a complicated medical protocol (e.g., insulin injection) may

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preclude an individual from remaining in the military. Soldiers also must adhere to specific fitness requirements and complete an annual physical fitness test that includes sit-ups, push-ups and a twomile run (based on age). A soldier who is determined high-risk and non-deployable may be discharged from the military.

PUBLIC HEALTH IMPACT Dr. Mathewson-Chapman said the Navy Reserve, the Peace Corps and other VISNs have expressed interest in developing FEDS_HEAL programs. The state of Florida is interested in FEDS_HEAL because it is improving the health of its citizens and an underserved population. In a state such as Florida, with a high density of military bases and reserve armories, the public health impact is significant, Dr. Mathewson-Chapman noted.

As another benefit, FEDS_HEAL introduces potential, future veterans (i.e., honorably discharged soldiers who have spent months or more in active duty) to the VA early in their military careers and establishes a level of comfort and familiarity with the VHA system.

Mental health assessment will be the program's crowning achievement. Plagued by an increasing rate of suicide, domestic violence and potential postdischarge homelessness, the VHA is developing programs to assist soldiers in coping with pre- and postdeployment stress (which may encompass marital, family and job stress, in addition to PTSD). The VHA could provide pre- and postdeployment health evaluations and also treat high-risk conditions that may hinder deployability.

MANY BENEFITS Overall, the program benefits multiple parties. Reservists' health needs are met; the VA gains a new, younger and healthier patient population (1,600 veterans die each day); and, if the preventive measures are effective, the program will save the government money in health care expenditures, improve veterans' quality of life, and more.

"We spend so much money on training in the military, but all that money has gone to waste if soldiers are not healthy enough to get on the plane to accomplish the mission," said Dr. Mathewson-Chapman. * Claudia Stahl Gagliardi is a free-lance writer for ADVANCE.

ADVANCE for Nurses Online

1/7/2002

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