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Mog AC, Benson SK, Sriskantharajah V, Kelly PA, Gray KE, Callegari LS, Moy EM, Katon JG. "You want people to listen to you": Patient experiences of women's healthcare within the Veterans Health Administration. Health Serv Res 2024. [PMID: 38804072 DOI: 10.1111/1475-6773.14324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To identify constructs that are critical in shaping Veterans' experiences with Veterans Health Administration (VA) women's healthcare, including any which have been underexplored or are not included in current VA surveys of patient experience. DATA SOURCES AND STUDY SETTING From June 2022 to January 2023, we conducted 28 semi-structured interviews with a diverse, national sample of Veterans who use VA women's healthcare. STUDY DESIGN Using VA data, we divided Veteran VA-users identified as female into four groups stratified by age (dichotomized at age 45) and race/ethnicity (non-Hispanic White vs. all other). We enrolled Veterans continuously from each recruitment strata until thematic saturation was reached. DATA COLLECTION/EXTRACTION METHODS For this qualitative study, we asked Veterans about past VA healthcare experiences. Interview questions were guided by a priori domains identified from review of the literature, including trust, safety, respect, privacy, communication and discrimination. Analysis occurred concurrently with interviews, using inductive and deductive content analysis. PRINCIPAL FINDINGS We identified five themes influencing Veterans' experiences of VA women's healthcare: feeling valued and supported, bodily autonomy, discrimination, past military experiences and trauma, and accessible care. Each emergent theme was associated with multiple of the a priori domains we asked about in the interview guide. CONCLUSIONS Our findings underscore the need for a measure of patient experience tailored to VA women's healthcare. Existing patient experience measures used within VA fail to address several aspects of experience highlighted by our study, including bodily autonomy, the influence of past military experiences and trauma on healthcare, and discrimination. Understanding distinct factors that influence women and gender-diverse Veterans' experiences with VA care is critical to advance efforts by VA to measure and improve the quality and equity of care for all Veterans.
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Affiliation(s)
- Ashley C Mog
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Samantha K Benson
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Vyshnika Sriskantharajah
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - P Adam Kelly
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kristen E Gray
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - Lisa S Callegari
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ernest M Moy
- Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Jodie G Katon
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Goldstein KM, Patel DB, Van Loon KA, Shapiro A, Rushton S, Lewinski AA, Lanford TJ, Cantrell S, Zullig LL, Wilson SM, Shepherd-Banigan M, Alton Dailey S, Sims C, Robinson C, Chawla N, Bosworth HB, Hamilton A, Naylor J, Gierisch JM. Optimizing the Equitable Deployment of Virtual Care for Women: Protocol for a Qualitative Evidence Synthesis Examining Patient and Provider Perspectives Supplemented with Primary Qualitative Data. Health Equity 2023; 7:570-580. [PMID: 37731781 PMCID: PMC10507937 DOI: 10.1089/heq.2023.0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Women experience numerous barriers to patient-centered health care (e.g., lack of continuity). Such barriers are amplified for women from marginalized communities. Virtual care may improve equitable access. We are conducting a partner-engaged, qualitative evidence synthesis (QES) of patients' and providers' experiences with virtual health care delivery for women. Methods We use a best-fit framework approach informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework and Public Health Critical Race Praxis. We will supplement published literature with qualitative interviews with women from underrepresented communities and their health care providers. We will engage patients and other contributors through multiple participatory methods. Results Our search identified 5525 articles published from 2010 to 2022. Sixty were eligible, of which 42 focused on women and 24 on provider experiences. Data abstraction and analysis are ongoing. Discussion This work offers four key innovations to advance health equity: (1) conceptual foundation rooted in an antiracist action-oriented praxis; (2) worked example of centering QES on marginalized communities; (3) supplementing QES with primary qualitative information with populations historically marginalized in the health care system; and (4) participatory approaches that foster longitudinal partnered engagement. Health Equity Implications Our approach to exploring virtual health care for women demonstrates an antiracist praxis to inform knowledge generation. In doing so, we aim to generate findings that can guide health care systems in the equitable deployment of comprehensive virtual care for women.
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Affiliation(s)
- Karen M. Goldstein
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Dhara B. Patel
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Katherine A. Van Loon
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Abigail Shapiro
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Sharron Rushton
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Allison A. Lewinski
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Tiera J. Lanford
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Sarah Cantrell
- School of Medicine, Duke University Medical Center Library, Durham, North Carolina, USA
| | - Leah L. Zullig
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Sarah M. Wilson
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Megan Shepherd-Banigan
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Margolis Center for Health Policy, Durham, North Carolina, USA
- VA VISN-6 Mid-Atlantic Mental Illness Research and Education Clinical Center, Durham, North Carolina, USA
| | - Susan Alton Dailey
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
| | - Catherine Sims
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Department of Medicine, Division of Rheumatology, Duke University, Durham, North Carolina, USA
| | - Cheryl Robinson
- Clinical Translational Sciences Institute, School of Medicine, Duke University, Durham, North Carolina, USA
- Veteran Research Engagement Panel, VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Neetu Chawla
- VA Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, California, USA
| | - Hayden B. Bosworth
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Alison Hamilton
- VA Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jennifer Naylor
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
- VA VISN-6 Mid-Atlantic Mental Illness Research and Education Clinical Center, Durham, North Carolina, USA
| | - Jennifer M. Gierisch
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
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3
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Rose DE, Oishi SM, Farmer MM, Bean-Mayberry B, Canelo I, Washington DL, Yano EM. Association Between Availability of Women's Health Services and Women Veterans' Care Experiences. Womens Health Issues 2022; 32:623-632. [PMID: 36115812 DOI: 10.1016/j.whi.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Few studies have focused on determinants of women's ratings of care experiences in primary care. We assessed associations between availability of women's health services and women veterans' ratings of care experiences. METHODS In a cross-sectional analysis, we linked Fiscal Year 2017 (October 1, 2016, to September 30, 2017) survey data from 126 Veterans Health Administration (VA) primary care leaders to 4,254 women veterans' ratings of care from VA's Survey of Health care Experiences of Patients-Patient Centered Medical Home (2017). The dependent variables were ratings of optimal access (appointments, information), care coordination, comprehensiveness (behavioral health assessment), patient-provider communication, and primary care provider. Key independent variables were number of women's health services 1) routinely available all weekday hours (compared with some hours or not available) and 2) available in VA general primary care vs. other arrangements. In multilevel logistic regression models, we adjusted for patient-, facility-, and area-level characteristics. RESULTS A greater number of women's health services routinely available in VA primary care was associated with a higher likelihood of optimal ratings of care coordination (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.01-1.10), provider communication (AOR, 1.08; 95% CI, 1.002-1.16), and primary care provider (AOR, 1.07; 95% CI, 1.02-1.13). A greater number of services available in VA primary care was associated with a lower likelihood of optimal ratings for access (AOR, 0.94; 95% CI, 0.88-0.99). CONCLUSION For the most part, routine availability of women's health services in VA primary care clinics enhanced women's health care experiences. These empirical findings offer health care leaders evidence-based approaches for improving women's care experiences.
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Affiliation(s)
- Danielle E Rose
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California.
| | - Sabine M Oishi
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Melissa M Farmer
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Bevanne Bean-Mayberry
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Ismelda Canelo
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Donna L Washington
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
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4
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Hamilton AB, Olmos-Ochoa TT, Canelo I, Rose D, Hoggatt KJ, Than C, Yano EM. Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women's health care implementation in low-performing VA facilities. Implement Sci Commun 2020; 1:59. [PMID: 32885214 PMCID: PMC7427959 DOI: 10.1186/s43058-020-00038-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background Women’s Health Services (WHS) in the Veterans Health Administration (VA) has long partnered with VA researchers to evaluate how VA care is organized for women veterans. This partnership has yielded substantial evidence of (1) variations in women veterans’ access to comprehensive healthcare services that contribute to disparities in quality and patient experience and (2) the positive impacts of gender-specific care models for women veterans’ quality and satisfaction. In an effort to provide support specifically to sites that were low-performing in women’s health, WHS and the VA Quality Enhancement Research Initiative co-funded an effort to roll out and evaluate evidence-based quality improvement (EBQI), an implementation strategy with demonstrated effectiveness in a prior cluster randomized trial in women’s health clinics. Methods We will identify 21 low-performing VA facilities through a combination of practice data, VA quality metrics (by gender), and other indicators. In partnership with WHS, an EBQI contractor will deliver the EBQI “package”—local consensus development and priority setting using stakeholder panels, multilevel stakeholder engagement, practice facilitation, local EBQI team training, and formative feedback—to participating sites. We propose a dynamic wait-listed design to evaluate the WHS plans for seven EBQI launches per year over 3 years. The goal is to evaluate (1) barriers and facilitators to achieving delivery of comprehensive women’s health care in low-performing VA facilities; (2) effectiveness of EBQI in supporting low-performing VA facilities to achieve improved practice features (e.g., level of comprehensive services available, care coordination arrangements, Patient Aligned Care Team (PACT) features implemented, environment of care improvements), provider/staff attitudes (e.g., improved gender awareness, women’s health knowledge and practice), quality of care, and patient experience; and (3) contextual factors, local implementation processes, and organizational changes over time. Discussion Access to comprehensive women’s health care reduces fragmentation of care, improves patient satisfaction, and results in better patient outcomes. We hypothesize that EBQI implementation will result in changes in leadership awareness and buy-in, multilevel engagement in problem-solving, an enhanced culture of quality improvement, structural changes in care, improved provider/staff attitudes, and better quality and patient experience. Trial registration ClinicalTrials.gov, NCT03238417. Registered 3 August 2017. Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03238417
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Affiliation(s)
- Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095 USA
| | - Tanya T Olmos-Ochoa
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 USA
| | - Ismelda Canelo
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 USA
| | - Danielle Rose
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 USA
| | - Katherine J Hoggatt
- Research Service, San Francisco VA Health Care System, San Francisco, CA 94121 USA.,Department of Medicine, University of California San Francisco, San Francisco, CA 94115 USA
| | - Claire Than
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073 USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095 USA.,Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095 USA
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5
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Gray KE, Ma EW, Callegari LS, Magnusson SL, Tartaglione EV, Christy AY, Katon JG. Understanding Variation in Availability and Provision of Minimally Invasive Hysterectomy: A Qualitative Study of Department of Veterans Affairs Gynecologists. Womens Health Issues 2020; 30:200-206. [DOI: 10.1016/j.whi.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 12/30/2022]
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6
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Mattocks K, Casares J, Brown A, Bean-Mayberry B, Goldstein KM, Driscoll M, Haskell S, Bastian L, Brandt C. Women Veterans’ Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care. Womens Health Issues 2020; 30:113-119. [DOI: 10.1016/j.whi.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/20/2019] [Accepted: 10/07/2019] [Indexed: 12/20/2022]
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7
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Than C, Chuang E, Washington DL, Needleman J, Canelo I, Meredith LS, Yano EM. Understanding Gender Sensitivity of the Health Care Workforce at the Veterans Health Administration. Womens Health Issues 2020; 30:120-127. [PMID: 32094056 DOI: 10.1016/j.whi.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Gender sensitivity of providers and staff has assumed increasing importance in closing historical gender disparities in health care quality and outcomes. The Department of Veterans Affairs (VA) has implemented several initiatives intended to improve gender sensitivity of its health care workforce. The current study examines practice- and individual-level characteristics associated with gender sensitivity of primary care providers (PCPs) and staff. METHODS We surveyed PCPs and staff (nurses, medical assistants, and clerks) at 12 VA medical centers (VAMCs) (n = 256 of 649; response rate, 39%). Gender sensitivity was measured using a 10-item scale adapted from the Gender Awareness Inventory-VA. We used weighted multivariate regression with maximum likelihood estimation to identify individual- and practice-level characteristics associated with gender sensitivity of PCPs and staff. RESULTS PCPs and staff had similar gender sensitivity but differed in most characteristics associated with that gender sensitivity. Among PCPs, women's health training and positive communication with others in the clinic were associated with greater gender sensitivity. For staff, prior work experience caring for women, working in Women's Health Patient-Aligned Care Teams, and rural location were associated with greater gender sensitivity, whereas more years of VA service was associated with lower gender sensitivity. Working at VA medical centers with a higher volume of women veteran patients was associated with greater gender sensitivity for both PCPs and staff. CONCLUSIONS Women's health training and experience in working with other women's health professionals are strongly correlated with greater gender sensitivity in the clinical workforce.
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Affiliation(s)
- Claire Than
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
| | - Donna L Washington
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, California
| | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
| | - Ismelda Canelo
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California.
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8
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Affiliation(s)
- Janet K. Han
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, CA (J.K.H., R.E.)
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles (J.K.H., K.E.W., R.E.)
| | - Elizabeth M. Yano
- Veterans Affairs Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, CA (E.M.Y.)
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health (E.M.Y.)
| | - Karol E. Watson
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles (J.K.H., K.E.W., R.E.)
| | - Ramin Ebrahimi
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, CA (J.K.H., R.E.)
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles (J.K.H., K.E.W., R.E.)
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9
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McCall JD, Tsai J. Characteristics and Health Needs of Veterans in Jails and Prisons: What We Know and Do Not Know about Incarcerated Women Veterans. Womens Health Issues 2017; 28:172-180. [PMID: 29217313 DOI: 10.1016/j.whi.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/28/2017] [Accepted: 10/13/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The majority of U.S. veterans in prisons and local jails are men, but incarcerated women veterans remain an important and understudied group. METHODS This study reported differences in sociodemographic, health, and criminal justice characteristics using Veterans Affairs (VA) administrative data on a national sample of 30,964 incarcerated veterans (30,440 men and 524 women) who received outreach from the VA Health Care for Reentry Veterans program between 2007 and 2011. Descriptive statistics and multivariable logistic regressions determined gender and racial differences in this population. RESULTS Compared with incarcerated veterans who were men, incarcerated women veterans were younger (d = 0.68), had significantly lower lifetime arrests (AOR, 0.65; p < .001; 99% CI, 0.49-0.87), and were less likely to have been incarcerated for a violent offense (AOR, 0.47; p < .001; 99% CI, 0.35-0.63). Notably, 58% of women were of reproductive age. Women were more likely to have reported eye problems, hypertension, chronic obstructive pulmonary disease, and seizure disorder, and were more likely to receive a preliminary diagnosis of mood disorder than men. Women were more likely to have received VA benefits, used VA health care before, and be willing to use VA services after release. A few important differences emerged when stratified by race. CONCLUSIONS These findings suggest that incarcerated women veterans are interested in VA health care services, but there is lack of information about women's health needs through the Health Care for Reentry Veterans program. The inclusion of Health Care for Reentry Veterans screening questions about women's health issues may support the VA's interests to better engage women veterans in care.
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Affiliation(s)
- Janice D McCall
- Carlow University, Department of Social Work, Pittsburgh, Pennsylvania; Veterans Affairs Healthcare System, Center for Health Equity Research and Promotion (CHERP), Pittsburgh, Pennsylvania
| | - Jack Tsai
- Veterans Affairs New England Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Veterans Affairs National Center on Homelessness Among Veterans, West Haven, Connecticut.
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10
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Reddy SM, Rose DE, Burgess JF, Charns MP, Yano EM. The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration. Womens Health Issues 2016; 26:648-655. [PMID: 27745998 DOI: 10.1016/j.whi.2016.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 08/15/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Increasing numbers of women veterans present an organizational challenge to a health care system that historically has served men. Women veterans require comprehensive women's health services traditionally not provided by the Veterans Health Administration. OBJECTIVE Examine the association of organizational factors and adoption of comprehensive women's health care. STUDY DESIGN Cross-sectional analysis of the 2007 Veterans Health Administration National Survey of Women Veterans Health Programs and Practices. METHODS Dependent measures included a) model of women's health care: separate women's health clinic (WHC), designated women's health provider in primary care (DWHP), both (WHC+DWHP), or neither and b) the availability of five women's health services: cervical cancer screening and evaluation and management of vaginitis, menstrual disorders, contraception, and menopause. Exposure variables were organizational factors drawn from the Greenhalgh model of diffusion of innovations including measures of structure, absorptive capacity, and system readiness for innovation. RESULTS The organizational factors of a gynecology clinic, an academic affiliation with a medical school, a women's health representative on one or more high-impact committees, and a greater caseload of women veterans were more common at sites with WHCs and WHC+DWHPs, compared with sites relying on general primary care with or without a DWHP. Academic affiliation and high-impact committee involvement remained significant in multivariable analysis. Sites with WHCs or WHC+DWHPs were more likely to offer all five women's health services. CONCLUSION Facilities with greater apparent absorptive capacity (academic affiliation and women's health representation on high-impact committees) are more likely to adopt WHCs. Facilities with separate WHCs are more likely to deliver a package of women's health services, promoting comprehensive care for women veterans.
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Affiliation(s)
- Shivani M Reddy
- Department of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts; Center for Advanced Methods Development, RTI International, Waltham, Massachusetts.
| | - Danielle E Rose
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - James F Burgess
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; Department of Health Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; Department of Health Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
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11
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Bergman AA, Frankel RM, Hamilton AB, Yano EM. Challenges with delivering gender-specific and comprehensive primary care to women veterans. Womens Health Issues 2015; 25:28-34. [PMID: 25530547 DOI: 10.1016/j.whi.2014.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 10/07/2014] [Accepted: 10/10/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services. METHODS We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics. RESULTS Inductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics. CONCLUSION Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action.
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Affiliation(s)
- Alicia A Bergman
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California.
| | - Richard M Frankel
- Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Special Services for Women in Substance Use Disorders Treatment: How Does the Department of Veterans Affairs Compare with Other Providers? Womens Health Issues 2015; 25:666-72. [PMID: 26329259 DOI: 10.1016/j.whi.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/21/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gender is an important consideration in the treatment of substance use disorders (SUD). Although the number of women seeking care through the Department of Veterans Affairs (VA) has increased dramatically, little is known about the capacity of the VA to meet the needs of women with SUD. We examined the prevalence of programs and key services for women in VA facilities in a survey of 14,311 SUD treatment facilities. METHODS Using data from the 2012 National Survey of Substance Abuse Treatment Services, we calculated the percent of VA facilities offering special programs or groups exclusively for women, compared with facilities under other types of ownership. For each ownership type, we also calculated the mean number of ancillary services offered that are critical for many women in SUD treatment, including child care, domestic violence counseling, and transportation assistance. Multivariable models were used to adjust for differences in other facility characteristics. FINDINGS Approximately 31% of facilities had special programs exclusively for women. The VA had the lowest prevalence of programs for women, at 19.1%; however, the VA offered an average of 5 key services for women, which was significantly higher than the averages for other federal (n = 2), local (n = 4), and private for-profit (n = 2) facilities. Results were generally robust to multivariable adjustments. CONCLUSIONS The VA should consider developing more SUD programs and groups exclusively for women, while maintaining ancillary services at their relatively abundant level. Gender-specific programs and groups could serve as points of referral to ancillary services for women veterans.
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Villagran M, Ledford CJW, Canzona MR. Women's Health Identities in the Transition From Military Member to Service Veteran. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1125-1132. [PMID: 26305865 DOI: 10.1080/10810730.2015.1018619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As servicewomen leave behind their military rank and status to become veterans, they must learn to effectively navigate a fragmented structure of care and communicate their health care needs. This study proposes a culture-centered approach to understanding how structural changes contribute to a reduction in positive health perception and behavior as active duty servicewomen transition to a veteran status. Results suggest during the process of disengagement from military cultural norms, women veterans' health care prevention service utilization decreases, and their physical and mental health decreases through the transition. These findings highlight the need for widely available and culturally appropriate programs to meet the needs of this unique patient population.
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Affiliation(s)
- Melinda Villagran
- a Department of Communication Studies , Texas State University , San Marcos , Texas , USA
| | - Christy J W Ledford
- b Department of Biomedical Informatics , Uniformed Services University of the Health Sciences , Bethesda , Maryland , USA
| | - Mollie Rose Canzona
- c Department of Communication , Wake Forest University , Winston-Salem , North Carolina , USA
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Goodcase ET, Love HA, Ladson E. A Conceptualization of Processing Military Sexual Trauma Within the Couple Relationship. CONTEMPORARY FAMILY THERAPY 2015. [DOI: 10.1007/s10591-015-9354-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reproductive Life Planning in Primary Care: A Qualitative Study of Women Veterans' Perceptions. Womens Health Issues 2015; 25:548-54. [PMID: 26123640 DOI: 10.1016/j.whi.2015.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women veterans using Veterans Administration (VA) health care have high rates of medical and mental health comorbidities, placing them at increased risk of poor outcomes from unplanned pregnancy. Reproductive life planning is a strategy recommended by the U.S. Centers of Disease Control and Prevention that could promote healthy pregnancies and reduce unplanned pregnancy in the VA. However, no data exist on women veterans' perceptions of reproductive life planning discussions. METHODS We trained six VA primary care physicians at two VA Women's Health Clinics to conduct reproductive life planning discussions with veterans aged 18 to 44 during primary care visits. After the visit, we performed semistructured telephone interviews with consenting veterans to explore perceptions of 1) reproductive life planning content and 2) provider-patient communication in reproductive life planning discussions. Interviews were audiorecorded, transcribed, and analyzed using content analysis. RESULTS We interviewed 27 veterans with a mean age of 31 years (range, 22-42). Women veterans perceived generally reproductive life planning discussions as important opportunities to discuss reproductive goals with providers and to obtain new and relevant information about contraception, planning healthy pregnancies, and available VA reproductive health services. Perceptions of reproductive life planning content were influenced by women's pregnancy intentions. Perceptions related to provider-patient communication included preferences for provider-initiated discussions and nonjudgmental counseling that incorporates patients' values and preferences. CONCLUSIONS Women veterans perceived reproductive life planning as valuable and important to their health. Reproductive life planning has the potential to enhance patient-centered delivery of reproductive health services in VA primary care.
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Gynecologists in the VA: do they enhance availability of sex-specific services and policies in the emergency department? Med Care 2015; 53:S76-80. [PMID: 25767980 DOI: 10.1097/mlr.0000000000000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine the association between on-site gynecology and availability of sex-specific services and policies in Department of Veterans Affairs (VA) emergency departments (EDs). RESEARCH DESIGN Cross-sectional analysis using data from a VA national inventory of emergency services for women and gynecologist staffing information from the VA Office of Productivity, Efficiency, and Staffing. SUBJECTS ED directors from all VA medical centers (N=120). MEASURES We used logistic regression to evaluate the association between on-site gynecologist full-time equivalents (FTEs, <0.5 and ≥0.5), and availability of sex-specific ED services, such as consult and follow-up within VA by a gynecologist, emergency contraception, rho (D) immunoglobulin, pelvic ultrasound, and transfer policies for obstetric and gynecologic emergencies. All analyses were adjusted for number of ED encounters by women. RESULTS Greater gynecologist FTE (≥0.5 vs. <0.5) was associated with increased odds of on-site availability of a gynecology consultation in the ED [odds ratio (OR)=10.9; 95% confidence interval (CI): 3.2, 36.6] and gynecologist follow-up within VA after an ED encounter (OR=2.5; 95% CI: 1.0, 6.2). A positive trend was seen in availability of rho (D) immunoglobulin (OR=1.4; 95% CI: 0.6, 3.5) and presence of transfer policies for obstetric (OR=1.7; 95% CI: 0.7, 4.5) and gynecologic emergencies (OR=1.6; 95% CI: 0.6, 4.2). Half of the facilities with <0.5 FTE did not have transfer policies in place or under development. CONCLUSIONS On-site gynecologist FTE is associated with improved availability of sex-specific care in EDs. Development of transfer processes for obstetric and gynecologic emergencies in settings with limited on-site gynecology is needed.
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Early lessons learned in implementing a women's health educational and virtual consultation program in VA. Med Care 2015; 53:S88-92. [PMID: 25767983 DOI: 10.1097/mlr.0000000000000313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many Veterans Health Administration primary care providers (PCPs) have small female patient caseloads, making it challenging for them to build and maintain their women's health (WH) knowledge and skills. To address this issue, we implemented a longitudinal WH-focused educational and virtual consultation program using televideo conferencing. OBJECTIVE To perform a formative evaluation of the program's development and implementation. RESEARCH DESIGN We used mixed methods including participant surveys, semi-structured interviews, stakeholder meeting field notes, and participation logs. We conducted qualitative content analysis for interviews and field notes, and quantitative tabulation for surveys and logs. SUBJECTS Veterans Health Administration WH PCPs. RESULTS In 53 postsession surveys received, 47(89%) agreed with the statement, "The information provided in the session would influence my patient care." Among 18 interviewees, all reported finding the program useful for building and maintaining WH knowledge. All interviewees also reported that sessions being conducted during their lunch hour limited consistent participation. Logs showed that PCPs participated more consistently in the 1 health care system that provided time specifically allocated for this program. Key stakeholder discussions revealed that rotating specialists and topics across the breadth of WH limited submission of cases. CONCLUSIONS Our WH education and virtual consultation program is a promising modality for building and maintaining PCP knowledge of WH, and influencing patient care. However, allocated time for PCPs to participate is essential for robust and consistent participation. Narrowing the modality's focus to gynecology, rather than covering the breadth WH topics, may facilitate PCPs having active cased-based questions for sessions.
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Women with breast cancer in the Veterans Health Administration: demographics, breast cancer characteristics, and trends. Med Care 2015; 53:S149-55. [PMID: 25767969 DOI: 10.1097/mlr.0000000000000299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An increasing number of women are being cared for within the Veterans Health Administration (VA). However, the demographics and trends of women with breast cancer at the VA has not been documented. We describe the demographics and breast cancer characteristics of the 4445 women enrolled in the VA and reported to the Department of Veterans Affairs Central Cancer Registry diagnosed with breast cancer from 1995 to 2012. The cases of breast cancer per year increased over time to 365 in 2012. Black women represented only 16% of women diagnosed with breast cancer in the VA in 1995-1999 but increased to 25% by 2010-2012 (P<0.001). The median age at diagnosis in 1995-1999 was 58.4 and decreased to 56.8 by 2010-2012 (P<0.02). The fraction of breast cancers that were node negative was 45% in 1995-1999 and increased to 64% in 2010-2012; correspondingly, women presented at an earlier stage in more recent years (P<0.001). Urban women with breast cancer cared for within the VA are more likely to be younger (P=0.04) and nonwhite (P<0.001) compared with rural women, but the breast tumor characteristics appear similar. Oncology physicians at the VA must be prepared to care for breast cancer among women as the number of cases is growing. With only 365 women diagnosed with breast cancer at the VA as per year 2012 and nearly 150 treating VA facilities, the number of breast cancer patients seen by a particular physician could be quite low, and this fact suggests a need for an evaluation of the quality and outcomes of breast cancer care at the VA.
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Readying the workforce: evaluation of VHA's comprehensive women's health primary care provider initiative. Med Care 2015; 53:S39-46. [PMID: 25767974 DOI: 10.1097/mlr.0000000000000298] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Veterans Health Administration (VHA) primary care providers (PCPs) often see few women, making it challenging to maintain proficiency in women's health (WH). Therefore, VHA in 2010 established Designated WH Providers, who would maintain proficiency in comprehensive WH care and be preferentially assigned women patients. OBJECTIVE To evaluate early implementation of this national policy. METHODS At each VHA health care system (N=140), the Women Veterans Program Manager completed a Fiscal Year 2012 workforce capacity assessment (response rate, 100%), representing the first time the national Designated WH Provider workforce had been identified. Assessment data were linked to administrative data. RESULTS Of all VHA PCPs, 23% were Designated WH Providers; 100% of health care systems and 83% of community clinics had at least 1 Designated WH Provider. On average, women veterans comprised 19% (SD=27%) of the patients Designated WH Providers saw in primary care, versus 5% (SD=7%) for Other PCPs (P<0.001). For women veterans using primary care (N=313,033), new patients were less likely to see a Designated WH Provider than established women veteran patients (52% vs. 64%; P<0.001). CONCLUSIONS VHA has achieved its goal of a Designated WH Provider in every health care system, and is approaching its goal of a Designated WH Provider at every hospital/community clinic. Designated WH Providers see more women than do Other PCPs. However, as the volume of women patients remains low for many providers, attention to alternative approaches to maintaining proficiency may prove necessary, and barriers to assigning new women patients to Designated WH Providers merit attention.
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deKleijn M, Lagro-Janssen AL, Canelo I, Yano EM. Creating a roadmap for delivering gender-sensitive comprehensive care for women Veterans: results of a national expert panel. Med Care 2015; 53:S156-64. [PMID: 25767971 PMCID: PMC4379113 DOI: 10.1097/mlr.0000000000000307] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in environments sensitive to their needs. OBJECTIVES We sought to determine what aspects of care need to be tailored to the needs of women Veterans in order for the VA to deliver gender-sensitive comprehensive care. RESEARCH DESIGN Modified Delphi expert panel process. SUBJECTS Eleven clinicians and social scientists with expertise in women's health, primary care, and mental health. MEASURES Importance of tailoring over 100 discrete aspects of care derived from the Institute of Medicine's definition of comprehensive care and literature-based domains of sex-sensitive care on a 5-point scale. RESULTS Panelists rated over half of the aspects of care as very-to-extremely important (median score 4+) to tailor to the needs of women Veterans. The panel arrived at 14 priority recommendations that broadly encompassed the importance of (1) the design/delivery of services sensitive to trauma histories, (2) adapting to women's preferences and information needs, and (3) sex awareness and cultural transformation in every facet of VA operations. CONCLUSIONS We used expert panel methods to arrive at consensus on top priority recommendations for improving delivery of sex-sensitive comprehensive care in VA settings. Accomplishment of their breadth will require national, regional, and local strategic action and multilevel stakeholder engagement, and will support VA's national efforts at improving customer service for all Veterans.
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Affiliation(s)
- Miriam deKleijn
- Department of Primary and Community Care, Gender and Women's Health Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antoine L.M. Lagro-Janssen
- Department of Primary and Community Care, Gender and Women's Health Unit, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ismelda Canelo
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, Sepulveda
| | - Elizabeth M. Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, Sepulveda
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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Bean-Mayberry B, Bastian L, Trentalange M, Murphy TE, Skanderson M, Allore H, Reyes-Harvey E, Maisel NC, Gaetano V, Wright S, Haskell S, Brandt C. Associations between provider designation and female-specific cancer screening in women Veterans. Med Care 2015; 53:S47-54. [PMID: 25767975 PMCID: PMC5477654 DOI: 10.1097/mlr.0000000000000323] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2010, the Department of Veterans Affairs Healthcare System (VA) implemented policy to provide Comprehensive Primary Care (for acute, chronic, and female-specific care) from designated Women's Health providers (DWHPs) at all VA sites. However, since that time no comparisons of quality measures have been available to assess the level of care for women Veterans assigned to these providers. OBJECTIVES To evaluate the associations between cervical and breast cancer screening rates among age-appropriate women Veterans and designation of primary-care provider (DWHP vs. non-DWHP). RESEARCH DESIGN Cross-sectional analyses using the fiscal year 2012 data on VA women's health providers, administrative files, and patient-specific quality measures. SUBJECTS The sample included 37,128 women Veterans aged 21 through 69 years. MEASURES Variables included patient demographic and clinical factors (ie, age, race, ethnicity, mental health diagnoses, obesity, and site), and provider factors (ie, DWHP status, sex, and panel size). Screening measures were defined by age-appropriate subgroups using VA national guidelines. RESULTS Female-specific cancer screening rates were higher among patients assigned to DWHPs (cervical cytology 94.4% vs. 91.9%, P<0.0001; mammography 86.3% vs. 83.3%, P<0.0001). In multivariable models with adjustment for patient and provider characteristics, patients assigned to DWHPs had higher odds of cervical cancer screening (odds ratio, 1.26; 95% confidence interval, 1.07-1.47; P<0.0001) and breast cancer screening (odds ratio, 1.24; 95% CI, 1.10-1.39; P<0.0001). CONCLUSIONS As the proportion of women Veterans increases, assignment to DWHPs may raise rate of female-specific cancer screening within VA. Separate evaluation of sex neutral measures is needed to determine whether other measures accrue benefits for patients with DWHPs.
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Affiliation(s)
- Bevanne Bean-Mayberry
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, University of Connecticut Health Center, Farmington
| | - Mark Trentalange
- Department of Internal Medicine, School of Medicine, New Haven, CT
| | | | | | - Heather Allore
- Department of Internal Medicine, School of Medicine, New Haven, CT
| | | | - Natalya C. Maisel
- VA Palo Alto Health Care System, HSR&D Center for Innovation to Implementation (Ci2i), Palo Alto, CA
| | - Vera Gaetano
- VA Connecticut HSR&D Pain, Research, Informatics, Multimorbidities, and Education (Prime) Center, West Haven, CT
| | - Steven Wright
- Office of Analytics & Business Intelligence (10P2B), Durham, NC
| | - Sally Haskell
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, School of Medicine, New Haven, CT
- Women’s Health Services, Patient Care Services, VA Central Office, Washington, DC
| | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven
- Yale University School of Medicine, Yale Center for Medical Informatics, West Haven, CT
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Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA Patient Aligned Care Teams. J Gen Intern Med 2014; 29 Suppl 2:S703-7. [PMID: 24715395 PMCID: PMC4070234 DOI: 10.1007/s11606-013-2699-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Veterans Health Administration (VA) has undertaken a major initiative to transform primary care delivery through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home concept, PACTs aim to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient driven and patient centered. However, how PACT principles should be applied to meet the needs of special populations, including women veterans, is not entirely clear. While historical differences in military participation meant women veterans were rarely seen in VA healthcare settings, they now represent the fastest growing segment of new VA users. They also have complex healthcare needs, adding gender-specific services and other needs to the spectrum of services that the VA must deliver. These trends are changing the VA landscape, introducing challenges to how VA care is organized, how VA providers need to be trained, and how VA considers implementation of new initiatives, such as PACT. We briefly describe the evolution of VA primary care delivery for women veterans, review VA policy for delivering gender-sensitive comprehensive primary care for women, and discuss the challenges that women veterans' needs pose in the context of PACT implementation. We conclude with recommendations for addressing some of these challenges moving forward.
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Lutwak N. Emergency department screening for military sexual trauma at VA healthcare system. J Emerg Med 2014; 46:535-536. [PMID: 24199720 DOI: 10.1016/j.jemermed.2013.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 08/18/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Nancy Lutwak
- VA New York Harbor Healthcare System, NYU School of Medicine, New York, New York
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Scheuner MT, Hamilton AB, Peredo J, Sale TJ, Austin C, Gilman SC, Bowen MS, Goldzweig CL, Lee M, Mittman BS, Yano EM. A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians. Genet Med 2013; 16:60-9. [DOI: 10.1038/gim.2013.75] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 04/16/2013] [Indexed: 02/04/2023] Open
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Slaghuis SS, Strating MMH, Bal RA, Nieboer AP. A measurement instrument for spread of quality improvement in healthcare. Int J Qual Health Care 2013; 25:125-31. [PMID: 23422040 DOI: 10.1093/intqhc/mzt016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop and test a measurement instrument for spread of quality improvement in healthcare. The instrument distinguishes: (i) spread of work practices and their results and (ii) spread practices and effectiveness. Relations between spread and sustainability of changed work practices were also explored to assess convergent validity. DESIGN We developed and tested a measurement instrument for spread in a follow-up study. The instrument consisted of 18-items with four subscales. SETTING AND PARTICIPANTS The sample consisted of former improvement teams in a quality improvement program for long-term care (nteams = 73, nrespondents = 127). Data were collected in a questionnaire about 1 year post-pilot site improvement implementation. INTERVENTIONS Quality improvements in long-term care practices. MAIN OUTCOME MEASURES Four variables were construed: (i) actions for spread of work practices, (ii) actions for spread of results, (iii) effectiveness of spread of work practices and (iv) effectiveness of spread of results. RESULTS Psychometric analysis yielded positive results on the item level. The intended four-factor model yielded satisfactory fit. The internal consistency of each scale was fine (Cronbach's α 0.70-0.93). Bivariate correlations revealed that the spread variables were strongly related but distinct, and positively related to the sustainability variables. CONCLUSIONS The psychometric properties are in line with methodological standards. Convergent validity was confirmed with sustainability. The measurement instrument offers a good starting point for the analysis of spread.
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Affiliation(s)
- S S Slaghuis
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS. J Int AIDS Soc 2013; 16:17433. [PMID: 23336725 PMCID: PMC3545274 DOI: 10.7448/ias.16.1.17433] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 10/25/2012] [Accepted: 12/05/2012] [Indexed: 12/02/2022] Open
Abstract
Introduction The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care. Methods A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines. Results and discussion The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research. Conclusions This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV-positive women's health outcomes.
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Lutwak N, Dill C. Letter to the Editor: Organizational Changes at VA Will Support Quality Improvement in Women’s Health Care. Am J Med Qual 2013; 28:84. [DOI: 10.1177/1062860612463166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yoon J, Scott JY, Phibbs CS, Frayne SM. Trends in rates and attributable costs of conditions among female VA patients, 2000 and 2008. Womens Health Issues 2012; 22:e337-44. [PMID: 22555220 DOI: 10.1016/j.whi.2012.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 02/15/2012] [Accepted: 03/09/2012] [Indexed: 10/28/2022]
Abstract
RESEARCH OBJECTIVE We examined rates of specific health conditions among female veteran patients and how the share of health care costs attributable to these conditions changed in the Veterans Affairs system between 2000 and 2008. METHODS Veterans' Administration (VA)-provided and VA-sponsored inpatient, outpatient, and pharmacy utilization and cost files were analyzed for women veterans receiving care in 2000 and 2008. We estimated rates of 42 common health conditions and per-patient condition costs from a regression model and calculated the total population costs attributable to each condition and changes by year. RESULTS The number of female VA patients increased from 156,305 in 2000 to 266,978 in 2008; 88% were under 65 years of age. The rate of women treated for specific conditions increased substantially for many gender-specific and psychiatric conditions: For example, pregnancy increased 133%, diagnosed posttraumatic stress disorder increased 106%, and diagnosed depression increased 41%. Mean costs of care increased from $4,962 per woman in 2000 to $6,570 per woman in 2008. Psychiatric conditions accounted for more than one quarter of population health care costs in 2008. Gender-specific conditions and musculoskeletal diseases accounted for a rising share of population costs and rose to 8.2% and 8.7% of population costs in 2008, respectively. CONCLUSION Gender-specific, cancer, musculoskeletal, and mental health and substance use disorders accounted for a greater share of overall costs during the study period and were primarily driven by higher rates of diagnosed conditions and, for several conditions, higher treatment costs.
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Affiliation(s)
- Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California 94025, USA.
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Borrero S, Mor MK, Zhao X, McNeil M, Ibrahim S, Hayes P. Contraceptive care in the VA health care system. Contraception 2012; 85:580-8. [DOI: 10.1016/j.contraception.2011.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/17/2011] [Accepted: 10/19/2011] [Indexed: 10/14/2022]
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Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan veterans. Med Care 2012; 50:347-52. [PMID: 22422055 DOI: 10.1097/mlr.0b013e318245a738] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Female Veterans comprise 12% of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, the largest proportion of women to serve of any prior cohort. We sought to determine the sex-specific risk of using a Veterans Health Administration (VHA) homeless program among OEF/OIF Veterans and to identify factors associated with increased risk of program use for women compared with men. METHODS We included OEF/OIF Veterans with at least 1 VHA clinical visit between October 1, 2001, and September 30, 2009. The study's outcome was the time to first use of a VHA homeless program. Cox proportional-hazards regression was used to estimate the relative risk of using a homeless program by sex, adjusting for relevant sociodemographic and clinical variables. Exploratory analyses examined interactions between sex and all covariates. RESULTS Of 445,319 Veterans, 7431 (1.7%) used a VHA homeless program, of which 961 were females (1.8%), and 6470 were males (1.7%) during a median follow-up period of 3.20 years. Women were as likely as men to use a homeless program (adjusted hazard ratio, 1.02; 95% confidence interval, 0.95-1.09); median time to first use was similar for female and male Veterans (1.88 vs. 1.88 y, respectively, P=0.53). In exploratory analyses, we found increased risk of program use for women compared with men for the following subgroups: ages 26-35 years, 100% service-connected disability rating, posttraumatic stress disorder diagnosis, and northeast location. CONCLUSIONS Overall, there was no substantial difference in the sex-specific risk of using a VHA homeless program. In light of this finding, VHA homeless programs must be prepared to recognize and address the unique needs of female OEF/OIF Veterans.
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MacGregor C, Hamilton AB, Oishi SM, Yano EM. Description, development, and philosophies of mental health service delivery for female veterans in the VA: a qualitative study. Womens Health Issues 2011; 21:S138-44. [PMID: 21724133 DOI: 10.1016/j.whi.2011.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE National Veterans Health Administration (VA) organizational data suggested the presence of separate and formal mental health services for female veterans, prompting qualitative exploration of their structure and development. METHODS Semistructured telephone interviews were conducted with a purposeful sample of 36 VA mental health administrators and providers from 26 VA Medical Centers and large community-based outpatient clinics that reported having separate women's mental health clinics and/or designated women's mental health providers in their outpatient mental health clinics. MAIN FINDINGS VA facilities have implemented a spectrum of women's mental health service delivery arrangements, including specialized mental health providers, co-located mental health providers in women's health clinics, women-only mental health groups, and women's mental health clinics. Most facilities had one or more "champions" developing such services, but some faced challenges in maintaining viability. Some respondents expressed concern about possible stigmatization associated with creating separate mental health services for female veterans. CONCLUSION Arrangements of VA mental health services for female veterans vary across facilities. This study identified a lack of consensus in the field regarding the need for and consequences of adapting existing programs specifically for the mental health needs of female veterans. Implementation of VA policy may require greater attention to frontline providers' perspectives. Comparative impact studies of female veterans' mental health service delivery arrangements are also needed.
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Affiliation(s)
- Casey MacGregor
- VA HSR&D Center of Excellence for Study of Healthcare Provider Behavior, Sepulveda, California 91343, USA.
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Washington DL, Bean-Mayberry B, Mitchell MN, Riopelle D, Yano EM. Tailoring VA primary care to women veterans: association with patient-rated quality and satisfaction. Womens Health Issues 2011; 21:S112-9. [PMID: 21724130 DOI: 10.1016/j.whi.2011.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 03/26/2011] [Accepted: 04/15/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary care delivery models tailored to women's needs and preferences are associated with higher quality and satisfaction. Therefore, the U.S. Department of Veterans Affairs (VA) recommends adoption of designated providers for women in primary care clinics or women's health centers as the optimal models for women's primary care. We assessed women veterans' ratings of their VA health care quality, gender-related satisfaction, gender appropriateness, and VA provider skills in treating women, in relation to primary care model at VA sites nationwide. METHODS Health care ratings were obtained from VA users in the 2008-2009 National Survey of Women Veterans. VA administrative data identified the site for each respondent's primary care. Facility data identified the site's primary care model for women. We conducted multilevel modeling to compare health care ratings for sites serving 300 or more women veterans who had adopted VA recommendations for women's primary care models (adopter sites), with non-adopter sites, and with small sites serving fewer women veterans, adjusting for patient characteristics. RESULTS Adopter sites received higher adjusted ratings of gender-related satisfaction and perceptions of VA provider skills than non-adopter and small sites. Adopter sites also received higher adjusted ratings of gender appropriateness than small sites. Adjusted ratings of quality of care did not differ by type of site. CONCLUSION VA sites with primary care models tailored to women were rated higher on most dimensions of care. Facilitating establishment of these optimal care models at other sites is one strategy for improving women veterans' experiences with VA care. Research to identify other features of care associated with quality could inform ongoing VA quality transformation efforts.
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Affiliation(s)
- Donna L Washington
- VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence, Sepulveda, California, USA.
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Hyun JK, Kimerling R, Cronkite RC, McCutcheon S, Frayne SM. Organizational factors associated with screening for military sexual trauma. Womens Health Issues 2011; 22:e209-15. [PMID: 22055987 DOI: 10.1016/j.whi.2011.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/12/2011] [Accepted: 09/14/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE This exploratory study investigated organizational factors associated with receipt of military sexual trauma (MST) screening during an early timeframe of the Veterans Health Administration's (VHA) implementation of the universal MST screening policy. METHODS The sample consisted of all VHA patients eligible for MST screening in fiscal year 2005 at 119 VHA facilities. Analyses were conducted separately by gender and by user status (i.e., new patients to the VHA health care system in FY 2005 and continuing users who had previously used the VHA health care system in the past year). Multivariate generalized estimating equations were used to assess the effects of facility-level characteristics and adjusted for person-level covariates. RESULTS Facility-level mandatory universal MST screening policies were associated with increased odds of receiving MST screening among new female patients and both continuing and new male patients: Odds ratio (OR), 2.87 (95% confidence interval [CI], 1.39-5.89) for new female patients; OR, 8.15 (95% CI, 2.93-22.69) for continuing male patients; and OR, 4.48 (95% CI, 1.79-11.20) for new male patients. Facility-level audit and feedback practices was associated with increased odds of receiving MST screening among new patients: OR, 1.91 (95% CI, 1.26-2.91) for females and OR, 1.86 (95% CI, 1.22-2.84) for males. Although the facility-level effect for women's health clinic (WHC) did not emerge as significant, patient-level effects indicated that among these facilities, women who used a WHC had greater odds of being screened for MST compared with women who had not used a WHC: OR, 1.79 (95% CI, 1.18-2.71) for continuing patients and OR, 2.20 (95% CI, 1.59-3.04) for new patients. CONCLUSION This study showed that facility policies that promote universal MST screening, as well as audit and feedback practices at the facility, significantly improved the odds of patients receiving MST screening. Women veterans' utilization of a WHC was associated with higher odds of receiving MST screening. This study provides empirical support for the use of policies and audit and feedback practices which the VHA has used since the implementation of the MST screening directive to encourage compliance with VHA's MST screening policy and is likely associated with the present-day success in MST screening across all VHA facilities.
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Affiliation(s)
- Jenny K Hyun
- Office of Mental Health Services, Military Sexual Trauma Support Team, Department of Veterans Affairs, Washington, DC, USA.
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National Variations in VA Mental Health Care for Women Veterans. Womens Health Issues 2011; 21:S130-7. [DOI: 10.1016/j.whi.2011.04.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 11/22/2022]
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Leading the Nation in Women’s Health: The Important Role of Research. Womens Health Issues 2011; 21:S70-2. [DOI: 10.1016/j.whi.2011.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 11/20/2022]
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Bean-Mayberry B, Yano EM, Washington DL, Goldzweig C, Batuman F, Huang C, Miake-Lye I, Shekelle PG. Systematic Review of Women Veterans’ Health: Update on Successes and Gaps. Womens Health Issues 2011; 21:S84-97. [DOI: 10.1016/j.whi.2011.04.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 11/30/2022]
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Mattocks KM, Nikolajski C, Haskell S, Brandt C, McCall-Hosenfeld J, Yano E, Pham T, Borrero S. Women Veterans’ Reproductive Health Preferences and Experiences: A Focus Group Analysis. Womens Health Issues 2011; 21:124-9. [DOI: 10.1016/j.whi.2010.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 09/10/2010] [Accepted: 11/08/2010] [Indexed: 11/25/2022]
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Weisman CS, Chuang CH, Scholle SH. Still piecing it together: women's primary care. Womens Health Issues 2011; 20:228-30. [PMID: 20620910 DOI: 10.1016/j.whi.2010.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 05/09/2010] [Indexed: 10/19/2022]
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Wilmoth JM, London AS, Parker WM. Sex Differences in the Relationship between Military Service Status and Functional Limitations and Disabilities. POPULATION RESEARCH AND POLICY REVIEW 2010. [DOI: 10.1007/s11113-010-9191-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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SAMBAMOORTHI USHA, Shen C, Findley P, Frayne S, Banerjea R. Depression treatment patterns among women veterans with cardiovascular conditions or diabetes. World Psychiatry 2010; 9:177-82. [PMID: 20975865 PMCID: PMC2948721 DOI: 10.1002/j.2051-5545.2010.tb00306.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The study aimed to examine treatment patterns for depression among women veterans diagnosed with cardiovascular conditions or diabetes. We used longitudinal data from the 2002-2003 merged Veteran Health Administration (VHA) and Medicare files. Chi-square tests and multinomial logistic regression were performed to analyse depression treatment among veteran women with incident depressive episode and one of the following chronic conditions: diabetes or coronary artery disease or hypertension. Overall, 77% received treatment for depression, 54% with only antidepressants, 4% with only psychotherapy, and 19% with both. Multinomial logistic regression revealed that African American women were more likely to be in the no treatment group and were more likely than white women to receive psychotherapy rather than antidepressants. Older women and women with coronary artery disease only were less likely to receive treatment.
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Affiliation(s)
- USHA SAMBAMOORTHI
- New Jersey Veterans Administration Healthcare System, East Orange, NJ 07018,Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV,Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
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Worley MJ, Trim RS, Tate SR, Hall JE, Brown SA. Service utilization during and after outpatient treatment for comorbid substance use disorder and depression. J Subst Abuse Treat 2010; 39:124-31. [PMID: 20598832 PMCID: PMC5758480 DOI: 10.1016/j.jsat.2010.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 05/03/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
Patients with comorbid substance use disorder (SUD) and depression incur greater treatment costs than those with either disorder alone. Integrated treatment targeting both issues concurrently has been shown to reduce substance use and depression in this population, but little is known about the effects of such treatment on the utilization of costly health services. This study compared 18-month patterns of service utilization for 236 veterans with comorbid SUD depression randomly assigned to 6 months of either Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation Therapy. Treatment group differences were found for the utilization of psychotropic medication services and inpatient hospitalization. Higher rates of therapy attendance, lower baseline depression, and receiving ICBT all predicted shorter admissions for those hospitalized during treatment. Ethnicity and gender predicted medication service use both during and following treatment. The findings provide evidence supporting the long-term cost-effectiveness of integrated treatment for this high-risk population.
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Affiliation(s)
- Matthew J Worley
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, La Jolla, CA, USA.
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Duggal M, Goulet JL, Womack J, Gordon K, Mattocks K, Haskell SG, Justice AC, Brandt CA. Comparison of outpatient health care utilization among returning women and men veterans from Afghanistan and Iraq. BMC Health Serv Res 2010; 10:175. [PMID: 20565985 PMCID: PMC2910695 DOI: 10.1186/1472-6963-10-175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 06/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of women serving in the United States military increased during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), leading to a subsequent surge in new women Veterans seeking health care services from the Veterans Administration (VA). The objective of this study was to examine gender differences among OEF/OIF Veterans in utilization of VA outpatient health care services. METHODS Our retrospective cohort consisted of 1,620 OEF/OIF Veterans (240 women and 1380 men) who enrolled for outpatient healthcare at a single VA facility. We collected demographic data and information on military service and VA utilization from VA electronic medical records. To assess gender differences we used two models: use versus nonuse of services (logistic regression) and intensity of use among users (negative binomial regression). RESULTS In our sample, women were more likely to be younger, single, and non-white than men. Women were more likely to utilize outpatient care services (odds ratio [OR] = 1.47, 95% confidence interval [CI]:1.09, 1.98), but once care was initiated, frequency of visits over time (intensity) did not differ by gender (incident rate ratio [IRR] = 1.07; 95% CI: 0.90, 1.27). CONCLUSION Recently discharged OEF/OIF women Veterans were more likely to seek VA health care than men Veterans. But the intensity of use was similar between women and men VA care users. As more women use VA health care, prospective studies exploring gender differences in types of services utilized, health outcomes, and factors associated with satisfaction will be required.
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Affiliation(s)
- Mona Duggal
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
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Bean-Mayberry B, Yano EM, Mor MK, Bayliss NK, Xu X, Fine MJ. Does sex influence immunization status for influenza and pneumonia in older veterans? J Am Geriatr Soc 2009; 57:1427-32. [PMID: 19515114 PMCID: PMC2785130 DOI: 10.1111/j.1532-5415.2009.02316.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the prevalence of influenza and pneumococcal immunization rates according to sex in a national sample of older veterans in the Department of Veterans Affairs (VA) healthcare system. DESIGN Retrospective, cross-sectional. SETTING VA healthcare system. PARTICIPANTS Current VA healthcare system users aged 65 and older eligible for immunization in fiscal years 2001 to 2003 (N=48,424 patient records). MEASUREMENTS Generalized estimating equations were performed to analyze combined chart review and administrative data to determine effect of sex on receipt of influenza and pneumococcal immunizations. RESULTS Unadjusted immunization rates were higher for men than women for influenza (73% vs 69%) and pneumococcal (87% vs 83%) vaccine. Adjusting for demographics, clinical comorbidities, use, and region, women had significantly lower odds of influenza (odds ratio (OR)=0.85, 95% confidence interval (CI=0.79-0.92) and pneumococcal (OR=0.77, 95% CI=0.71-0.84) immunization. CONCLUSION Older female veterans have lower rates of immunization than older male veterans in VA settings. Although VA remains above community levels for immunization, older female veterans will benefit from targeted efforts to increase immunization prevalence.
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Affiliation(s)
- Bevanne Bean-Mayberry
- Veterans Affairs Greater Los Angeles Health Services Research and Development Center of Excellence, Center for Study of Health Care Provider Behavior, Sepulveda, California, USA.
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Kelly MM, Vogt DS, Scheiderer EM, Ouimette P, Daley J, Wolfe J. Effects of military trauma exposure on women veterans' use and perceptions of Veterans Health Administration care. J Gen Intern Med 2008; 23:741-7. [PMID: 18414956 PMCID: PMC2517864 DOI: 10.1007/s11606-008-0589-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 01/18/2008] [Accepted: 02/05/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few studies have addressed how military trauma exposure, particularly sexual assault and combat exposure, affects women veterans' use and perceptions of Veterans Health Administration (VHA) care. OBJECTIVE The aim of the present study was to evaluate the effects of military sexual assault and combat exposure on women veterans' use and perceptions of different aspects of VHA care. DESIGN Cross-sectional telephone survey of a national sample of women veterans. PARTICIPANTS Women from the VA's National Registry of Women Veterans. MEASUREMENTS Sociodemographic characteristics, VHA care utilization, perceptions of care. RESULTS Women veterans with histories of military sexual assault reported more use of VHA services, but less satisfaction, poorer perceptions of VHA facilities and staff, and more problems with VHA services compared to women veterans without histories of sexual assault. Combat exposure was related to more problems with VHA staff, although few other differences were observed for women with and without histories of combat exposure. CONCLUSIONS Findings provide information on areas that can be targeted with respect to caring for women veterans exposed to military sexual trauma and combat exposure, including improving interactions with VHA staff and the ease of using VHA services.
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Affiliation(s)
- Megan M Kelly
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.
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Availability of gynecologic services in the department of veterans affairs. Womens Health Issues 2008; 18:167-73. [PMID: 18329895 DOI: 10.1016/j.whi.2007.12.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 11/24/2007] [Accepted: 12/17/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE The optimum approach to providing the Congressionally mandated gender-specific services for which women veterans are eligible is unknown. We evaluated onsite availability of gynecologic services, clinic type and staffing arrangements, and the impact of having a gynecology clinic (GYN) and/or an obstetrician gynecologist (OBGYN) routinely available. METHODS We analyzed data from the 2001 national VHA Survey of Women Veterans Health Programs and Practices (n = 136 sites; response rate, 83%). We assessed availability of gynecologic services, and evaluated differences in availability by clinic type (designated women's health provider in primary care [PC], separate women's health clinic for primary care [WHC], and/or separate GYN) and staffing arrangements (OBGYN routinely involved versus not). MAIN FINDINGS Out of 133 sites, 77 sites (58%) offered services through a GYN and 56 sites (42%) did not have GYN. Seventy-two (54%) sites had a WHC. More sites with an OBGYN provided endometrial biopsies (91% vs. 20%), IUD insertion (85% vs. 14%), infertility evaluation (56% vs. 23%), infertility treatment (25% vs. none), gynecologic surgery (65 vs. 28%), p < .01. In comparison to sites without WHC, those with WHC were more likely to offer services onsite: endometrial biopsy odds ratio (OR) 6.0 (95% confidence interval [CI], 2.0-18.1); IUD insertion 4.4 (1.6-12.2); infertility evaluation 2.8 (1.2-6.3); and gynecologic surgery 2.3 (1.0-5.4). CONCLUSION As the VA develops strategic plans for accommodating the growing number of women veterans, leaders should consider focusing on establishing WHC for primary care and routine availability of OBGYN or other qualified clinicians, rather than establishing separate GYN.
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Bean-Mayberry B, Yano EM, Bayliss N, Navratil J, Weisman CS, Scholle SH. Federally funded comprehensive women's health centers: leading innovation in women's healthcare delivery. J Womens Health (Larchmt) 2008; 16:1281-90. [PMID: 18001184 DOI: 10.1089/jwh.2006.0284] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AIMS Women's healthcare has historically been fragmented, given the artificial separation of reproductive care from general medical care. Aiming to advance new care models for delivery of comprehensive, integrated clinical care for women, two federal agencies-the U.S. Department of Health and Human Services (DHHS) and Department of Veterans Affairs (VA)-launched specialized women's health centers (WHCs). Exemplars of comprehensive service delivery, these originally federally funded centers have served as foundations for innovations in delivering comprehensive care to women in diverse practice settings. Little is known, however, about details of their organization, staffing, practice arrangements, and service availability that might inform adoption of similar models in the community. METHODS Using comparable key informant surveys, we collected organizational data from the DHHS National Centers of Excellence (CoE) (n = 13) and the original VA comprehensive WHC's (n = 8). We abstracted supplemental data (e.g., academic affiliation) from the 2001 American Hospital Association (AHA) survey. RESULTS All DHHS and VA women's health programs served urban areas, and nearly all had academic partnerships. DHHS centers had three times the average caseload as did VA centers. Preventive cancer screening and general reproductive services were uniformly available at all centers, although DHHS centers offered extensive reproductive services on-site more frequently, and VA centers more often had on-site mental healthcare. CONCLUSIONS The DHHS and VA comprehensive WHCs share similar missions and comparable organization, education, and clinical services, demonstrating their commitment to reducing fragmented service delivery. Their common structural components present opportunities for further advancing women's quality of care across other systems of care.
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Affiliation(s)
- Bevanne Bean-Mayberry
- VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health- care System, Sepulveda, California 91343, USA.
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