Office of Public Health & Environmental Hazards

The WRIISC Experience with Gulf War Veterans and Chronic Multisymptom Illness
Drew Helmer, MD, MS War Related Illness and Injury Study System (WRIISC) VA-New Jersey Healthcare System

Deployment Healthcare
A holistic, efficient, and patient-centered approach to the care of combat veterans that proactively assesses for the common and distinct issues of this population and its subgroups.

Integrated Deployment Healthcare

Physical Concerns:

Primary Care Provider

Psychological Concerns:

Veteran

Mental Health Provider

Psycho-social Concerns:

Social Worker

The War Related Illness and Injury Study Center (WRIISC)

A national program in the Department of Veterans Affairs (VA), initially established in 2001 to address deployment health issues from the First Gulf War.

ABOUT THE WRIISC

The WRIISC helps: Deployed Veterans Any era or conflict Unexplained or unusual health concerns Through: Clinical assessment Education Research Risk Communication

WRIISC Synergies
Research
Research produces knowledge and evidencesupported interventions and tools that can improve patient care and can be packaged and disseminated through education activities.

Education
Education of patients and providers can improve patient outcomes and identify gaps in knowledge to be addressed by research.

Clinical Care
Observations from clinical care lead to research questions and testable hypotheses, highlight gaps in provider and patient knowledge.

WRIISC REGIONAL MAP

CLINICAL EVALUATIONS
Comprehensive Interdisciplinary Evaluation
Focus is on symptom management and improving function Three day evaluation as pre-determined by WRIISC clinical team

Environmental Exposure Consults

Comprehensive available for Veterans of any conflict Attempts to link exposures to current health conditions Educates patient about his/her exposure concerns

eConsults
Medical record review with individualized recommendations for next steps prior to other WRIISC evaluations

Comprehensive Evaluation Patients Complex, deployment-related health concerns

Difficult to diagnosis, unexplained, or unusual

Concerns about deployment-related exposures

Environmental & Occupational

Local work up inconclusive or unavailable

WRIISC Model of Assessment & Care

Holistic/biopsychosocial approach Interdisciplinary team WRIISC team and patient craft goals & next steps (Road Map)
Focus on optimizing health and function Emphasize self-management Goal and outcome oriented

Encourage timely reassessment by PACT Follow up at 1, 6, and 12 months

Chronic Multisymptom Illness (CMI) at the WRIISC

Review of the referrals Team meeting and in the road map Use of labels for chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome

Symptoms reported by Veterans who completed NJ WRIISC intake packet

PHQ-15 symptom
Stomach pain

% Gulf War (n=46) 24.4

% OEF/OIF/OND (n=66) 19.7

Vietnam (n=28) 32.1

Back pain
Pain in your arms, legs, or joints (knees, hips, etc.) Menstrual cramps or other problem with your periods (Women only) Headaches Chest pain Dizziness Fainting spells Feeling your heart pound or race Shortness of breath Pain or problems during sexual intercourse Constipation, loose bowels, or diarrhea Nausea, gas, or indigestion Feeling tired or having low energy

71.1
80.0 15.8

62.1
53.0 9.1

46.4
60.7 0

48.9 11.1 17.8 0 15.6 26.7 29.5 48.9 48.9 91.1

39.4 9.2 31.8 4.6 27.3 17.2 27.3 45.5 39.4 78.8

17.9 10.7 7.1 0 3.6 32.1 28.0 25.9 36.0 55.6

Trouble sleeping

88.9
58.7

83.3
62.1

63.0
41.4

PHQ-Depression

PCL-PTSD (>50)

39.1

43.9

24.1

VHA encounters by GW Veterans before and after WRIISC Visit

(Samore et al, IDEAS Center, SLC VAMC)

ICD9 codes associated with GW Veterans VHA encounters before and after a WRIISC visit
(Samore et al, IDEAS Center, SLC VAMC)
7000
6000 5000 4000 3000
In the one year AFTER WRIISC Visit

In the one year PRIOR to WRIISC visit

2000 1000 0

WRIISC SUMMARY
1. The WRIISC provides holistic, multi-disciplinary clinical care to help deployed Veterans of any era improve their health, function, and quality of life. 2. The WRIISC mission of clinical care, research, education and risk communication represents an optimal approach to Veterans with complex, difficult to diagnose, unusual or unexplained deployment health concerns. 3. Chronic Multisymptom Illness is applied as a concept at the WRIISC, but not as a label. 4. The WRIISC clinical experience demonstrates patterns of symptoms in Gulf War Veterans superficially similar to other cohorts.

WRIISC CONTACT INFO

www.warrelatedillness.va.gov

Drew.Helmer@VA.gov
NJ WRIISC: 1-800-248-8005 or WRIISC.NJ@VA.GOV CA WRIISC: 1-888-482-4376 or WRIISC.CA@VA.GOV DC WRIISC: 1-800-722-8340 or WRIISC.DC@VA.GOV