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O'Mahen PN, Eck CS, Jiang C(R, Petersen LA. Contextual factors influencing the association between the Affordable Care Act's Medicaid expansion and Veteran VA-Medicaid dual enrollment. Health Serv Res 2024; 59:e14280. [PMID: 38258310 PMCID: PMC11063093 DOI: 10.1111/1475-6773.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To evaluate changes in dual enrollment after Affordable Care Act Medicaid expansion by VA priority group, (e.g., service connection), sex, and type of state expansion. STUDY SETTING Our cohort was all Veterans ages 18-64 enrolled in VA and eligible for benefits due to military service-connection or low income from 2011 to 2016; the unit of analysis was person-year. STUDY DESIGN Difference-in-difference and event-study analysis. The outcome was dual VA-Medicaid enrollment for at least 1 month annually. Medicaid expansion, VA priority status, whether a state expanded by a Section 1115 waiver, and sex were independent variables. We controlled for race, ethnicity, age, disease burden, distance to VA facilities, state, and year. DATA EXTRACTION METHODS We used data from the VA Corporate Data Warehouse (CDW) regarding age and VA Priority Group to select our cohort of VA-enrolled individuals. We then took the cohort and crossed checked it with Medicaid Analytic Extract (MAX) and T-MSIS Analytic Files (TAF) to determine Medicaid enrollment status. PRINCIPAL FINDINGS Service-connected Veterans experienced lower dual-enrollment increases across all sex and state-waiver groups (3.44 percentage points (95% CI: 1.83, 5.05 pp) for women, 3.93 pp (2.98, 4.98) for men, 4.06 pp (2.85, 5.27) for non-waiver states, and 3.00 pp (1.58 to 4.41) for waiver states) than Veterans who enrolled in the VA due to low income (8.19 pp (5.43, 10.95) for women, 9.80 pp (7.06, 12.54) for men, 10.21 pp (7.17, 13.25) for non-waiver states, and 7.39 pp (5.28, 9.50) for waiver states). CONCLUSIONS Medicaid expansion is associated with dual enrollment. Dual-enrollment changes are greatest in those enrolled in the VA due to low income, but do not differ by sex or expansion type. Results can help VA identify groups disproportionately likely to have potential care-coordination issues due to usage of multiple health care systems.
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Affiliation(s)
- Patrick N. O'Mahen
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical CenterVeterans Health Administration, U.S. Department of Veterans' AffairsHoustonTexasUSA
- Section for Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Chase S. Eck
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical CenterVeterans Health Administration, U.S. Department of Veterans' AffairsHoustonTexasUSA
- Section for Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Cheng (Rebecca) Jiang
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical CenterVeterans Health Administration, U.S. Department of Veterans' AffairsHoustonTexasUSA
- Section for Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Laura A. Petersen
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical CenterVeterans Health Administration, U.S. Department of Veterans' AffairsHoustonTexasUSA
- Section for Health Services Research, Department of MedicineBaylor College of MedicineHoustonTexasUSA
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Norvell DC, Turner AP, Morgenroth DC, Henderson AW, Halsne EG, Hurwitz M, Czerniecki JM. The effect of depression on prosthesis prescription in men and women who have undergone a lower limb amputation. Disabil Rehabil 2024; 46:1204-1211. [PMID: 37035925 DOI: 10.1080/09638288.2023.2192976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To determine gender disparities and potential factors that modify prosthesis prescription practices in veteran patients who have undergone their first major unilateral amputation due to diabetes or peripheral arterial disease. MATERIALS AND METHODS A retrospective cohort study using the VA Corporate Data Warehouse to compare prosthesis prescription rates and time to prescription between men and women veterans. The primary exposure was gender. The primary outcome was a qualifying prosthesis prescription within 12 months of the incident amputation. The secondary outcome was time to prosthesis prescription. Multiple logistic and linear regression was used to control for potential confounders and identify potential effect modification. RESULTS 2,862 individuals met study criteria, with 1690 (60%) prescribed a qualifying prosthesis. Men were more likely to receive a prosthesis prescription than women (59% versus 45%, respectively; p = 0.03). This difference was observed primarily among those with a diagnosis of major depressive disorder. In this subgroup, the odds of men receiving a prosthesis over women was over 3 times (adjusted odds ratio = 3.3; 95% Confidence Interval, 1.5, 7.4). Men had a mean shorter time to prescription compared to women (112 ± 72 versus 136 ± 79 days, respectively, p = 0.08). Depression in women negatively impacts their prosthesis prescription rates and time to prescription compared to men. This disparity may have significant impacts on future function and quality of life.Implications for RehabilitationThis study found that men more commonly received a prosthesis prescription and received it earlier than women.This disparity was most extreme among women who had been diagnosed with major depressive disorder.Providers should identify at risk patients early and consider targeted interventions to address depression during the preoperative and immediate postoperative phases.Future research should continue to work to identify gender-specific needs that exacerbate disparity.
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Affiliation(s)
- Daniel C Norvell
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - David C Morgenroth
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Alison W Henderson
- VA Puget Sound Health Care System, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Elizabeth G Halsne
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Max Hurwitz
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, PA, Pittsburgh
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
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Chung JS, Jouk A, Licona NP, Terry JH, Harris OA. In her own words: a phenomenological analysis of stories told by female service members and veterans after traumatic brain injury. Disabil Rehabil 2023; 45:4086-4093. [PMID: 36398683 DOI: 10.1080/09638288.2022.2146766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Given the majority of Service Members and Veterans (SMV) who have sustained a traumatic brain injury (TBI) are male, the female experience with TBI has not been captured in the general understanding of TBI. To improve understanding of the experience of female SMV after TBI utilizing a qualitative phenomenological approach on stories as told by female SMV. MATERIALS AND METHODS Ten female SMV participated in storytelling workshops and created video stories documenting their personal experience with TBI. Workshops were hosted by the VA Palo Alto Health Care System Polytrauma System of Care (VAPAHCS PSC). A grounded thematic analysis was conducted on the video stories. RESULTS Three common content themes emerged from all the stories: (1) negative psychological and emotional impacts of TBI, (2) acceptance and healing process associated with recovery, and (3) military contexts. Negative psychological and emotional impacts included intrapersonal impacts such as negative emotions, suicidal ideation, and dealing with cognitive and physical challenges, and interpersonal impacts in relationships and loss of independence. Notably, all the stories acknowledged an acceptance and healing process, characterized by several subthemes including motivational factors, TBI education, spirituality, and advocacy work. Lastly, each story mentioned military context, highlighting the unique experience within this population. CONCLUSIONS This phenomenological examination adds evidence-based understanding to the experience after TBI among female SMV. Each story uncovered nuanced and multifaceted issues that women experience in their TBI recovery. Our findings provide context to guide future intervention on the care, support, and TBI recovery for the female SMV population.
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Affiliation(s)
- Joyce S Chung
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexandra Jouk
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Nytzia P Licona
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- University of Illinois Chicago, Palo Alto, CA, USA
| | - Jennifer H Terry
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Odette A Harris
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford University, Stanford, CA, USA
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Differences in Burnout and Intent to Leave Between Women's Health and General Primary Care Providers in the Veterans Health Administration. J Gen Intern Med 2022; 37:2382-2389. [PMID: 34618305 PMCID: PMC9360298 DOI: 10.1007/s11606-021-07133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although they are a minority of patients served by the Veterans Health Administration (VHA), women Veterans comprise a fast-growing segment of these patients and have unique clinical needs. Women's health primary care providers (WH-PCPs) are specially trained and designated to provide care for women Veterans. Prior work has demonstrated that WH-PCPs deliver better preventative care and have more satisfied patients than PCPs without the WH designation. However, due to unique clinical demands or other factors, WH-PCPs may experience more burnout and intent to leave practice than general PCPs in the VHA. OBJECTIVE To examine differences in burnout and intent to leave practice among WH and general PCPs in the VHA. DESIGN Multi-level logistic regression analysis of three cross-sectional waves of PCPs within the VHA using the national All Employee Survey and practice data (2017-2019). We modeled outcomes of burnout and intent to leave practice as a function of WH provider designation, gender, and other demographics and practice characteristics, such as support staff ratio, panel size, and setting. PARTICIPANTS A total of 7903 primary care providers (5152 general PCPs and 2751 WH-PCPs; response rates: 63.9%, 65.7%, and 67.5% in 2017, 2018, and 2019, respectively). MAIN MEASURES Burnout and intent to leave practice. KEY RESULTS WH-PCPs were more burned out than general PCPs (unadjusted: 55.0% vs. 46.9%, p<0.001; adjusted: OR=1.29, 95% confidence interval [CI] 1.10-1.55) but did not have a higher intention to leave (unadjusted: 33.4% vs. 32.1%, p=0.27; adjusted: OR=1.07, CI 0.81-1.41). WH-PCPs with intentions to leave were more likely to select the response option of "job-related (e.g., type of work, workload, burnout, boredom)" as their primary reason to leave. CONCLUSIONS Burnout is higher among WH-PCPs compared to general PCPs, even after accounting for provider and practice characteristics. More research on causes of and solutions for these differences in burnout is needed.
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Postinjury Care and Complications Among U.S. Military Women With Combat-Related Major Limb Traumatic Amputation. J Trauma Nurs 2022; 29:57-64. [PMID: 35275105 DOI: 10.1097/jtn.0000000000000636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND U.S. servicewomen may be at greater risk of injury in future conflicts as they integrate into combat occupations. More than 1,000 servicewomen were wounded during military conflicts in Iraq and Afghanistan. Some women sustained traumatic amputations, and research on their postinjury health is needed. OBJECTIVE To describe acute care, complications, and health care utilization among servicewomen with combat-related amputations, comparing them with injured men. METHODS In this retrospective matched-pairs study, women were identified from the Expeditionary Medical Encounter Database between 2003 and 2012 and matched with men on amputation injuries, injury severity, and age. Differences were assessed with nonparametric tests for paired data. RESULTS Of 20 women identified for analysis, 13 received tourniquets, three were administered procoagulants, and six had massive transfusions. Women averaged 3.4 (SD = 1.6) postinjury complications, and the most frequent were heterotopic ossification (n = 17), posthemorrhagic anemias (n = 13), and bacterial wound infections (n = 10). Acute care and complications were similar among men. Women averaged more acute care days (M = 49.8, SD = 30.6) than men (M = 46.1, SD = 27.4) but fewer intensive care unit days (women: M = 2.6, SD = 4.0; men: M = 4.4, SD = 8.3). No statistical differences were observed. CONCLUSION Postinjury care among servicewomen with combat-related amputations was comparable with servicemen, and complications were common. This information can aid providers and nursing staff in the management of these injuries.
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Syler LB, Stobaugh CL, Foulis PR, Carlton GT, DeLand LA, Borkowski AA. Cervical Cancer Screening in South Florida Veteran Population, 2014 to 2020: Cytology and High-Risk Human Papillomavirus Correlation and Epidemiology. Cureus 2021; 13:e17247. [PMID: 34540473 PMCID: PMC8445854 DOI: 10.7759/cureus.17247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/16/2021] [Indexed: 01/09/2023] Open
Abstract
Objective This project aims to use our robust women's health patient data to analyze the correlation between cytology and high-risk human papillomavirus (Hr-HPV) testing, study the performance of Hr-HPV testing for detecting cytology lesions, and examine epidemiologic measures of human papillomavirus (HPV) infections in the women's veteran population. Methods We collected patient data from 2014 to 2020 from our computerized patient record system. We performed HPV assays using the cobas® 4800 system (Roche Diagnostics, Basel, Switzerland). The cobas HPV assay detects HPV 16, HPV 18, and 12 other HPV types (31, 33, 35, 39, 45, 51, 56, 58, 59, 66, and 68). We organized cytology results and Hr-HPV assays with Microsoft Access and Microsoft Excel (Microsoft Corporation, Washington, USA) for analysis. Results A total of 9437 cervical specimens were co-tested. High-grade cytology lesions - high-grade intraepithelial lesion (HSIL) or higher and atypical squamous cells, cannot exclude HSIL (ASC-H) - were overwhelmingly positive for Hr-HPV (94.1% and 87.2%, respectively). Low-grade cytology lesions - low-grade squamous intraepithelial lesion ((LSIL) and atypical squamous cells of undetermined significance (ASC-US) - were positive for Hr-HPV in lower percentages (72.6% and 54.9%, respectively). Hr-HPV testing had a sensitivity of 91.3%, a specificity of 93.1%, a positive predictive value of 16.4%, and a negative predictive value of 99.8% for detecting high-grade cytology lesions. Hr-HPV testing had a lower performance for detecting low-grade cytology lesions. Ten cases had high-grade cytology and negative Hr-HPV test. Out of 10 such patients, nine showed no dysplasia (six) or low-grade dysplasia (three) on subsequent biopsy. Overall, 14.4% of tests were positive for Hr-HPV. The highest positive Hr-HPV test rates were in the third and eighth decades of life, 25.1% and 22.0%, respectively. However, the eighth decade consisted of a small sample of only 50 women. In women over 30 years of age with Hr-HPV infections, HPV types 16 and 18 were present in 11.7% and 6.4% of tests, respectively. Other HPV types were present in 82.3% of tests. Conclusions Hr-HPV testing has a high performance in detecting high-grade cytology lesions and a lower performance for detecting low-grade cytology lesions. However, studies show that LSIL rarely progresses to cervical intraepithelial neoplasia grade 3 or higher (CIN3+), suggesting minimal to no impact on cervical cancer screening. We believe our findings are in accordance with recent studies and affirm the guidelines that recommend primary Hr-HPV testing as the preferred screening method. The percentage of positive Hr-HPV tests and rates for age and HPV types 16 and 18 in our women's veteran population suggest similar HPV prevalence to that of the general US population.
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Affiliation(s)
- Lee B Syler
- Pathology, University of South Florida, Tampa, USA
| | - Corinne L Stobaugh
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | - Philip R Foulis
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | - George T Carlton
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
| | | | - Andrew A Borkowski
- Pathology and Laboratory Medicine, James A. Haley Veterans' Hospital, Tampa, USA
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Sullivan-Baca E, Naylon K, Zartman A, Ardolf B, Westhafer JG. Gender Differences in Veterans Referred for Neuropsychological Evaluation in an Outpatient Neuropsychology Consultation Service. Arch Clin Neuropsychol 2020; 35:562-575. [PMID: 32128586 DOI: 10.1093/arclin/acaa008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The number of women veterans seeking Veterans Health Administration services has substantially increased over the past decade. Neuropsychology remains an understudied area in the examination of gender differences. The present study sought to delineate similarities and differences in men and women veterans presenting for neuropsychological evaluation in terms of demographics, referral, medical conditions, effort, and outcome diagnosis. METHOD A database collected from an outpatient VA neuropsychology clinic from 2013 to 2019 was analyzed (n = 232 women, 2642 men). Additional analyses examined younger (n = 836 men, 155 women) and older (n = 1805 men, 77 women) age cohorts. RESULTS Women veterans were younger and more educated than men, whereas men had higher prevalence of vascular risk factors. Both groups were most often referred from mental health clinics and memory was the most common referral question. Although men performed worse on performance validity measures, clinicians rated women as evidencing poorer effort on a cumulative rating based on formal and embedded performance validity measures, behavioral observations, and inconsistent test patterns. Older women reported more depressive symptoms than older men and were more commonly diagnosed with depression. CONCLUSIONS This exploratory study fills a gap in the understanding of gender differences in veterans presenting for neuropsychological evaluations. Findings emphasize consideration for the intersection of gender with demographics, medical factors, effort, and psychological symptoms by VA neuropsychologists. A better understanding of relationships between gender and these factors may inform neuropsychologists' test selection, interpretation of behavioral observations, and diagnostic considerations to best treat women veterans.
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Affiliation(s)
| | - Kara Naylon
- VA North Texas Healthcare System, Dallas, TX, USA
| | | | - Barry Ardolf
- VA North Texas Healthcare System, Dallas, TX, USA
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Tannahill HS, Livingston WS, Fargo JD, Brignone E, Gundlapalli AV, Blais RK. Gender moderates the association of military sexual trauma and risk for psychological distress among VA-enrolled veterans. J Affect Disord 2020; 268:215-220. [PMID: 32217254 DOI: 10.1016/j.jad.2020.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Military sexual trauma (MST) is associated with increased risk for posttraumatic stress disorder (PTSD) and depression diagnoses, as well as suicidal ideation/behavior (SI/B). Little is known about the differential effect of gender on the association of MST and the aforementioned mental health outcomes. As females are the fastest growing subpopulation of the Veterans Health Administration (VHA), it is imperative to assess possible between-gender differences in the association of MST with PTSD, depression, and SI/B. METHODS Participants were 435,690 (n = 382,021, 87.7% men) 9/11 era veterans seen for care at the VHA between 2004 and 2014. Demographics, gender, PTSD and depression diagnoses, SI/B, and MST screen status were extracted from medical records. Adjusted logistic regression models assessed the moderating effect of gender on the association of MST with PTSD and depression diagnoses, as well as SI/B. RESULTS Women with MST had a larger increased risk for a PTSD diagnosis (predicted probability =0.56, 95% confidence interval [CI] [0.56, 0.56]) and comparable risk for a depression diagnosis (predicted probability = 0.63, 95% CI [0.63, 0.64]) compared to men with MST. Men were more likely to have evidence of SI/B (predicted probability = 1.07, 95% CI [0.10, 0.11]) relative to women, but the interaction between gender and MST was nonsignificant. LIMITATIONS Data were limited to veterans seeking care through VHA and the MST screen did not account for MST severity. CONCLUSIONS Non-VHA settings may consider screening for MST in both men and women, given that risk for PTSD and depression is heightened among female survivors of MST.
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Affiliation(s)
- Hallie S Tannahill
- Department of Psychology, Utah State University, 2800 Old Main Hill, Logan, UT 84321, United States; Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT 84148, United States.
| | - Whitney S Livingston
- Department of Psychology, Utah State University, 2800 Old Main Hill, Logan, UT 84321, United States; Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT 84148, United States
| | - Jamison D Fargo
- Department of Psychology, Utah State University, 2800 Old Main Hill, Logan, UT 84321, United States; Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT 84148, United States
| | - Emily Brignone
- Department of Psychology, Utah State University, 2800 Old Main Hill, Logan, UT 84321, United States; Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT 84148, United States
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT 84148, United States; Departments of Internal Medicine and Biomedical Informatics, University of Utah School of Medicine, 30 N. 1900 E., Salt Lake City, UT 84132, United States
| | - Rebecca K Blais
- Department of Psychology, Utah State University, 2800 Old Main Hill, Logan, UT 84321, United States; Informatics, Decision Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, 500 Foothill Dr., Salt Lake City, UT 84148, United States
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Direct healthcare costs of spinal disorders in Brazil. Int J Public Health 2019; 64:965-974. [DOI: 10.1007/s00038-019-01211-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
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Lehavot K, Beckman KL, Chen JA, Simpson TL, Williams EC. Race/Ethnicity and Sexual Orientation Disparities in Mental Health, Sexism, and Social Support among Women Veterans. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2019; 6:347-358. [PMID: 31435497 PMCID: PMC6703561 DOI: 10.1037/sgd0000333] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To identify patterns of risk and resilience by the intersections of race/ethnicity and sexual orientation in mental health symptom severity, sexism, and social support among U.S. women veterans. METHODS A national sample of women veterans (n = 648, 38% sexual minority, 15% racial/ethnic minority) was recruited online in 2013 using social networking websites and listservs. Using cross-sectional survey data, we evaluated main and interactive associations between race/ethnicity and sexual orientation on depression, anxiety, posttraumatic stress, unhealthy alcohol use, sexism, and social support. Models were adjusted for other demographic characteristics. RESULTS Across depression, anxiety, and sexism, White heterosexual women reported the least distress and racial/ethnic minority heterosexual women the most distress (race/ethnicity x sexual orientation interactions p < .05). Among White women, sexual minority women reported greater levels of depression, anxiety, and sexism than heterosexual women. The effects were the opposite among racial/ethnic minority women, where heterosexual women reported similar or worse depression, anxiety, and sexism than sexual minority women. There were no race/ethnicity or sexual orientation interaction effects on posttraumatic stress symptoms or unhealthy alcohol use and marginally significant effects on social support. CONCLUSIONS Among women veterans, race/ethnicity and sexual orientation were associated with mental health and sexism, alone and in combination. Findings suggest that those who were both racial/ethnic and sexual minorities may develop resilience from their lived experience. On the other hand, women veterans with a minority race/ethnicity or a minority sexual orientation appeared more vulnerable to adverse outcomes and may need targeted care.
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Affiliation(s)
- Keren Lehavot
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Health Services, University of Washington
| | | | - Jessica A. Chen
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Tracy L. Simpson
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System
| | - Emily C. Williams
- Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research & Development, VA Puget Sound Health Care System
- Department of Health Services, University of Washington
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Nworah U, Symes L, Langford R, Young A. Understanding the meaning of seeking healthcare for Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) male veterans: An interpretive phenomenological study. Arch Psychiatr Nurs 2018; 32:769-776. [PMID: 30201207 DOI: 10.1016/j.apnu.2018.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Uchenna Nworah
- Michael E. DeBakey VA, Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, United States.
| | - Lene Symes
- Texas Woman's University, Nelda C. Stark College of Nursing, 6700 Fannin Street, Houston, TX 77030, United States.
| | - Rae Langford
- Texas Woman's University, Nelda C. Stark College of Nursing, 6700 Fannin Street, Houston, TX 77030, United States.
| | - Anne Young
- Texas Woman's University, Nelda C. Stark College of Nursing, 6700 Fannin Street, Houston, TX 77030, United States.
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Chanfreau-Coffinier C, Gordon HS, Schweizer CA, Bean-Mayberry BA, Darling JE, Canelo I, Yano EM. Mental Health Screening Results Associated with Women Veterans' Ratings of Provider Communication, Trust, and Care Quality. Womens Health Issues 2018; 28:430-438. [DOI: 10.1016/j.whi.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022]
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Hallett LD, Gerber MR. Human Papillomavirus Testing by Veterans Administration Women's Health Providers: Are They Adhering to Guidelines? J Womens Health (Larchmt) 2017; 27:179-182. [PMID: 28885082 DOI: 10.1089/jwh.2016.6141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Evidence-based guidelines have been created by professional societies, including the United States Preventive Services Task Force (USPSTF) and American Society for Colposcopy and Cervical Pathology (ASCCP), for use of human papillomavirus (HPV) cotesting in cervical cancer screening. We investigated whether Veterans Health Administration (VA) providers at one VA medical center follow these guidelines. MATERIALS AND METHODS Retrospective chart review of women aged 21-65 who had an HPV test ordered with pap testing in fiscal year 2014 at one Veterans Administration (VA) medical center to evaluate concordance of HPV ordering with screening (USPSTF) and management (ASCCP) guidelines. We collected data on patient characteristics and gynecologic history and documented the reason, if given, for HPV testing. RESULTS Of the 210 eligible HPV tests evaluated, 142 tests (68%) were determined to be guideline discordant. Of the 142 guideline-discordant tests, 90 had no documented reason for HPV testing in the chart. Site of care was not significant. CONCLUSIONS This study demonstrates potential overuse of HPV testing among women's health providers at one VA medical center. This may indicate that VA providers lack an understanding of HPV cotesting guidelines. Further studies are needed to characterize VA provider adherence to HPV testing guidelines nationally. Implementation of educational interventions and decision aids may improve VA providers' adherence to guidelines.
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Affiliation(s)
- Laura D Hallett
- 1 Department of Medicine, UMass Memorial Health Care , Worcester, Massachusetts
| | - Megan R Gerber
- 2 VA Boston Healthcare System , Jamaica Plain, Massachusetts.,3 Division of General Internal Medicine, Department of Medicine, Boston University School of Medicine , Boston, Massachusetts
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Reproductive health diagnoses of women veterans using department of Veterans Affairs health care. Med Care 2015; 53:S63-7. [PMID: 25767978 DOI: 10.1097/mlr.0000000000000295] [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 Little is known regarding the reproductive health needs of women Veterans using Department of Veterans Affairs (VA) health care. OBJECTIVE To describe the reproductive health diagnoses of women Veterans using VA health care, how these diagnoses differ across age groups, and variations in sociodemographic and clinical characteristics by presence of reproductive health diagnoses. RESEARCH DESIGN This study is a cross-sectional analysis of VA administrative and clinical data. SUBJECTS The study included women Veterans using VA health care in FY10. MEASURES Reproductive health diagnoses were identified through presence of International Classification of Disease, 9th Revision (ICD-9) codes in VA clinical and administrative records. The prevalence of specific diagnosis categories were examined by age group (18-44, 45-64, ≥65 y) and the most frequent diagnoses for each age group were identified. Sociodemographic and clinical characteristics were compared by presence of at least 1 reproductive health diagnosis. RESULTS The most frequent reproductive health diagnoses were menstrual disorders and endometriosis among those aged 18-44 years (n=16,658, 13%), menopausal disorders among those aged 45-64 years (n=20,707, 15%), and osteoporosis among those aged ≥65 years (n=8365, 22%). Compared with women without reproductive health diagnoses, those with such diagnoses were more likely to have concomitant mental health (46% vs. 37%, P<0.001) and medical conditions (75% vs. 63%, P<0.001). CONCLUSIONS Women Veterans using VA health care have diverse reproductive health diagnoses. The high prevalence of comorbid medical and mental health conditions among women Veterans with reproductive health diagnoses highlights the importance of integrating reproductive health expertise into all areas of VA health care, including primary, mental health, and specialty care.
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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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Abstract
As more women have joined the US military, there has been a shift in the overall veteran population. Those who served in the US military, especially women, have undergone experiences that will impact their overall health and wellbeing. It is therefore critical for providers to better understand US military culture and be prepared on how to ask patients about their military experience. Health care providers need to be aware of the unique medical, psychiatric, and psychosocial needs of women veterans in order to best serve this patient population.
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Affiliation(s)
- Ximena A Levander
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6421, USA.
| | - Maryann K Overland
- Department of Medicine, VA Puget Sound Health Care System, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195-6421, USA
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Oliva EM, Midboe AM, Lewis ET, Henderson PT, Dalton AL, Im JJ, Seal K, Paik MC, Trafton JA. Sex differences in chronic pain management practices for patients receiving opioids from the Veterans Health Administration. PAIN MEDICINE 2014; 16:112-8. [PMID: 25039721 DOI: 10.1111/pme.12501] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Women experience chronic pain and use pain-related health care at higher rates than men. It is not known whether the pain-related health care female veterans receive is consistent with clinical practice guideline recommendations or whether receipt of this care differs between men and women. OBJECTIVE The aim of this study was to identify whether sex differences in chronic pain management care exist for patients served by the Veterans Health Administration (VHA). DESIGN Data on patient demographics, diagnostic criteria, and health care utilization were extracted from VHA administrative databases for fiscal year 2010 (FY10). PATIENTS Patients in this study included all VHA patients (excluding metastatic cancer patients) who received more than 90 days of a short-acting opioid medication or a long-acting opioid medication prescription in FY10 study. MEASURES Multilevel logistic regressions were conducted to identify sex differences in receipt of guideline-recommended chronic pain management. RESULTS A total of 480,809 patients met inclusion criteria. Female patients were more likely to receive most measures of guideline-recommended care for chronic pain including mental health assessments, psychotherapy, rehabilitation therapy, and pharmacy reconciliation. However, women were more likely to receive concurrent sedative prescriptions, which is inconsistent with guideline recommendations. Most of the observed sex differences persisted after controlling for key demographic and diagnostic differences. CONCLUSIONS Findings suggest that female VHA patients are more likely to receive an array of pain management practices than male patients, including both contraindicated and recommended polypharmacy. Quality improvement efforts to address underutilization of mental health and rehabilitative services for pain by male patients and polypharmacy in female patients should be considered.
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Affiliation(s)
- Elizabeth M Oliva
- Department of Veterans Affairs, Center for Innovation to Implementation, Menlo Park, California, USA
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Rogers TJ, Smith BM, Weaver FM, Ganesh S, Saban KL, Stroupe KT, Martinez RN, Evans CT, Pape TLB. Healthcare utilization following mild traumatic brain injury in female veterans. Brain Inj 2014; 28:1406-12. [DOI: 10.3109/02699052.2014.919537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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LeMaster B, Quintiliani K, Hunt A. BRINGING COMMUNITIES AND THE UNIVERSITY TOGETHER: APPLIED ANTHROPOLOGY AT CALIFORNIA STATE UNIVERSITY, LONG BEACH. ANNALS OF ANTHROPOLOGICAL PRACTICE 2013. [DOI: 10.1111/napa.12023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Delcher C, Wang Y, Maldonado-Molina M. Trends in financial barriers to medical care for women veterans, 2003-2004 and 2009-2010. Prev Chronic Dis 2013; 10:E171. [PMID: 24157074 PMCID: PMC3809923 DOI: 10.5888/pcd10.130071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Women veterans are a fast-growing segment of the veteran population, yet they face many barriers to medical care. The objective of this study was to examine factors that put women veterans at risk for a financial barrier to medical care. METHODS We conducted repeated cross-sectional analyses of data from the 2003, 2004, 2009, and 2010 Behavioral Risk Factor Surveillance System. We used weighted logistic regression to examine the risk of a financial barrier to medical care as the primary outcome in a multivariate model controlling for factors in health-related domains. RESULTS In 2010, there were an estimated 1,719,750 (11.6%) working-aged veterans who needed to see a doctor in the previous 12 months but could not because of cost. For women, 13.4% faced this financial barrier. Over the study period, facing a financial barrier was consistently associated with insurance coverage, physical and mental distress days, and having children in the home. Other associations emerged in particular years, such as binge drinking in 2010. The trends for women veterans relative to men and for younger women veterans relative to older women veterans show reduction in financial barriers to health care. CONCLUSION The Veteran's Health Administration (VHA) should continue efforts to reduce financial and other barriers, especially among the higher risk groups we identified. This will help meet the VHA's objectives of providing comprehensive care to all veterans including women.
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Affiliation(s)
- Chris Delcher
- University of Florida, Department of Epidemiology, 2004 Mowry Rd, Gainesville, FL 32610. E-mail:
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Carlson KF, Taylor BC, Hagel EM, Cutting A, Kerns R, Sayer NA. Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison. Headache 2013; 53:1573-82. [PMID: 24102376 DOI: 10.1111/head.12216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care. BACKGROUND Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample. METHODS We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses. RESULTS In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back pain (38% vs 46%). CONCLUSIONS Results of this study have implications for the delivery of post-deployment health services to Iraq and Afghanistan War Veterans. Migraine and other headache diagnoses are common among Veterans, particularly women, and tend to occur in combination with other post-deployment health conditions for which patients are being treated.
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Affiliation(s)
- Kathleen F Carlson
- Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center (R&D 66), Portland, OR; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
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Ong SS, Sanka K, Mettu PS, Brosnan TM, Stinnett SS, Lee PP, Challa P. Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma. Ophthalmology 2013; 120:2462-2469. [PMID: 23916487 DOI: 10.1016/j.ophtha.2013.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. DESIGN Retrospective chart review. PARTICIPANTS One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. METHODS Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. MAIN OUTCOME MEASURES Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. RESULTS The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. CONCLUSIONS Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care.
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Affiliation(s)
- Sally S Ong
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Duke-NUS Graduate Medical School, Singapore, Republic of Singapore
| | - Krishna Sanka
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina; Eye Centers of Racine and Kenosha, Racine, Wisconsin
| | - Priyatham S Mettu
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | | | - Sandra S Stinnett
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Paul P Lee
- W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Pratap Challa
- Duke Eye Center, Duke University School of Medicine, Durham, North Carolina.
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Tsai J, David DH, Edens EL, Crutchfield A. Considering child care and parenting needs in Veterans Affairs mental health services. EVALUATION AND PROGRAM PLANNING 2013; 39:19-22. [PMID: 23570988 DOI: 10.1016/j.evalprogplan.2013.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/04/2013] [Accepted: 03/12/2013] [Indexed: 06/02/2023]
Abstract
Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans' access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop "family-friendly" mental health services.
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Affiliation(s)
- Jack Tsai
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), West Haven, CT 06516, United States.
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Health services research on women veterans: a critical partner on the road to patient-centered care. J Gen Intern Med 2013; 28 Suppl 2:S498-9. [PMID: 23807055 PMCID: PMC3695275 DOI: 10.1007/s11606-013-2472-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Allore HG, Ning Y, Brandt CA, Goulet JL. Accounting for the Hierarchical Structure in Veterans Health Administration Data: Differences in Healthcare Utilization between Men and Women Veterans. INTERNATIONAL JOURNAL OF STATISTICS IN MEDICAL RESEARCH 2013; 2:94-103. [PMID: 24910720 PMCID: PMC4047985 DOI: 10.6000/1929-6029.2013.02.02.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Women currently constitute 15% of active United States of America military service personnel, and this proportion is expected to double in the next 5 years. Previous research has shown that healthcare utilization and costs differ in women US Veterans Health Administration (VA) patients compared to men. However, none have accounted for the potential effects of clustering on their estimates of healthcare utilization. US Women Veterans are more likely to serve in specific military branches (e.g. Army), components (e.g. National Guard), and ranks (e.g. officer) than men. These factors may confer different risk and protection that can affect subsequent healthcare needs. Our study investigates the effects of accounting for the hierarchical structure of data on estimates of the association between gender and VA healthcare utilization. The sample consisted of data on 406,406 Veterans obtained from VA's Operation Enduring Freedom/Operation Iraqi Freedom roster provided by Defense Manpower Data Center - Contingency Tracking System Deployment File. We compared three statistical models, ordinary, fixed and random effects hierarchical logistic regression, in order to assess the association of gender with healthcare utilization, controlling for branch of service, component, rank, age, race, and marital status. Gender was associated with utilization in ordinary logistic and, but not in fixed effects hierarchical logistic or random effects hierarchical logistic regression models. This point out that incomplete inference could be drawn by ignoring the military structure that may influence combat exposure and subsequent healthcare needs. Researchers should consider modeling VA data using methods that account for the potential clustering effect of hierarchy.
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Affiliation(s)
| | - Yuming Ning
- Department of Internal Medicine, Yale School of Medicine, USA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare System, USA
- Department of Emergency Medicine, Yale School of Medicine, USA
| | - Joseph L. Goulet
- VA Connecticut Healthcare System, USA
- Department of Psychiatry, Yale School of Medicine, USA
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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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Maguen S, Cohen B, Cohen G, Madden E, Bertenthal D, Seal K. Gender differences in health service utilization among Iraq and Afghanistan veterans with posttraumatic stress disorder. J Womens Health (Larchmt) 2012; 21:666-73. [PMID: 22313026 DOI: 10.1089/jwh.2011.3113] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about gender differences in healthcare use among newly returning veterans with posttraumatic stress disorder (PTSD). We investigated gender differences in Veterans Affairs (VA) medical center health service use among Iraq and Afghanistan veterans with PTSD with and without comorbid depression and alcohol use disorders (AUD). METHODS Using VA administrative data, bivariate and multivariate statistics were used to examine gender differences in health service use among 159,705 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD seeking VA healthcare from October 7, 2001, to December 31, 2010. RESULTS Female veterans with PTSD were more likely to be black and single and to have higher mental health, primary care, and emergency care use compared to men with PTSD. Men were more likely to have higher mental health inpatient use compared to women. Women and men with comorbid PTSD and depression or comorbid PTSD and AUD were more likely to have higher use in all domains compared to their counterparts with PTSD without these comorbid disorders. Women with comorbid PTSD and depression were 12.5 times more likely to have a mental health inpatient hospitalization compared to their female counterparts without depression and twice as likely to have a mental health hospitalization compared to men with comorbid PTSD and depression. CONCLUSIONS Women with PTSD had higher use than men in almost all areas, as did all veterans with comorbid PTSD and depression and comorbid PTSD and AUD, regardless of gender. Better understanding these health service use differences will allow for targeted evaluation and integrated treatment interventions in veterans with PTSD.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, San Francisco, CA 94121, USA.
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Veghari G, Sedaghat M, Banihashem S, Moharloei P, Angizeh A, Tazik E, Moghaddami A. Trends in waist circumference and central obesity in adults, northern iran. Oman Med J 2012; 27:50-3. [PMID: 22359726 PMCID: PMC3282127 DOI: 10.5001/omj.2012.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/24/2011] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The main aim of this study is to determine the central obesity trends during the period from 2006 to 2010 among 15-65 years old people in Northern Iran. METHODS This was a population-based cross-sectional study conducted on 6466 subjects who had been chosen by a multi stage cluster random sampling within five steps. The subjects were randomly chosen from 325 clusters and each cluster included 20 cases. Central obesity was defined as waist circumference ³102 cm and ³88 cm in men and women, respectively. RESULTS Compared to 2010, the mean waist circumference in 2006 changed from 87.2 cm to 88.1 cm in men (p=0.237), and from 90.3 cm to 88.6 cm in women (p=0.045). The comparison between 2006 and 2010 revealed that the prevalence of central obesity slightly decreased, 6.8% and 2.4% in urban women and men, respectively. Generally, the mean of waist circumference significantly decreased in urban women (by 0.069 cm in each year; p=0.020); however, the decrease of waist circumference in urban men was not significant (0.006 cm decrease each year; p=0.915). CONCLUSION The prevalence of central obesity declined among both males and females in the urban area; however, there was an attenuated increasing trend in the rural area. The disparity of trends between the two regions should be considered for further study.
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Affiliation(s)
- Gholamreza Veghari
- Golestan Cardiovascular Research Center-School of Medicine - Golestan University of Medical Sciences .Gorgan, Iran
| | - Mehdi Sedaghat
- Deputy of Health, Golestan University of Medical Science. Iran
| | | | | | | | - Ebrahim Tazik
- Deputy of Health, Golestan University of Medical Science. Iran
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Yano EM, Bastian LA, Bean-Mayberry B, Eisen S, Frayne S, Hayes P, Klap R, Lipson L, Mattocks K, McGlynn G, Sadler A, Schnurr P, Washington DL. Using research to transform care for women veterans: advancing the research agenda and enhancing research-clinical partnerships. Womens Health Issues 2011; 21:S73-83. [PMID: 21724148 DOI: 10.1016/j.whi.2011.04.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/05/2011] [Accepted: 04/08/2011] [Indexed: 10/28/2022]
Abstract
The purpose of this paper is to report on the outcomes of the 2010 VA Women's Health Services Research Conference, which brought together investigators interested in pursuing research on women veterans and women in the military with leaders in women's health care delivery and policy within and outside the VA, to significantly advance the state and future direction of VA women's health research and its potential impacts on practice and policy. Building on priorities assembled in the previous VA research agenda (2004) and the research conducted in the intervening six years, we used an array of approaches to foster research-clinical partnerships that integrated the state-of-the-science with the informational and strategic needs of senior policy and practice leaders. With demonstrated leadership commitment and support, broad field-based participation, strong interagency collaboration and a push to accelerate the move from observational to interventional and implementation research, the Conference provided a vital venue for establishing the foundation for a new research agenda. In this paper, we provide the historical evolution of the emergence of women veterans' health services research and an overview of the research in the intervening years since the first VA women's health research agenda. We then present the resulting VA Women's Health Research Agenda priorities and supporting activities designed to transform care for women veterans in six broad areas of study, including access to care and rural health; primary care and prevention; mental health; post deployment health; complex chronic conditions, aging and long-term care; and reproductive health.
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Affiliation(s)
- Elizabeth M Yano
- VA Greater Los Angeles HSR&D Center of Excellence for Study of Healthcare Provider Behavior, Los Angeles, California 91343, USA.
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O'Toole TP, Pirraglia PA, Dosa D, Bourgault C, Redihan S, O'Toole MB, Blumen J. Building care systems to improve access for high-risk and vulnerable veteran populations. J Gen Intern Med 2011; 26 Suppl 2:683-8. [PMID: 21989622 PMCID: PMC3191220 DOI: 10.1007/s11606-011-1818-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND For many high-risk patients, accessing primary care is challenged by competing needs and priorities, socioeconomics, and other circumstances. The resulting lack of treatment engagement makes these vulnerable patient populations susceptible to poor health outcomes and an over-reliance on emergency department-based care. METHODS We describe a quasi-experimental pre-post study examining a vulnerable population-based application of the patient-centered medical home applied to four high-risk groups: homeless veterans, cognitively impaired elderly, women veterans and patients with serious mental illness. We measured 6-month primary care, emergency department and inpatient care use and chronic disease management when care was based in a general internal medicine clinic (2006) and in a population-specific medical home (2008). RESULTS Overall 457 patients were studied, assessing care use and outcomes for the last 6 months in each study year. Compared with 2006, in 2008 there was a significant increase in primary care use (p < 0.001) and improvement in chronic disease monitoring and diabetes control (2006 HBA1C: 8.5 vs. 2008 HBA1C 6.9) in all four groups. However, there was also an increase in both emergency department use and hospitalizations, albeit with shorter lengths of stay in 2008 compared with 2006. Most of the increased utilization was driven by a small proportion of patients in each group. CONCLUSION Tailoring the medical home model to the specific needs and challenges facing high-risk populations can increase primary care utilization and improve chronic disease monitoring and diabetes management. More work is needed in directing this care model to reducing emergency department and inpatient use.
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Affiliation(s)
- Thomas P O'Toole
- Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02918, USA. Thomas.O'
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Puri PR, Dimsdale JE. Health care utilization and poor reassurance: potential predictors of somatoform disorders. Psychiatr Clin North Am 2011; 34:525-44. [PMID: 21889677 PMCID: PMC3170079 DOI: 10.1016/j.psc.2011.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Somatoform disorders are common conditions, but the current diagnostic criteria are considered to be unreliable, based largely on medically unexplained symptoms. DSM-5 is considering other possible characteristics of somatizers including high utilization, dissatisfaction with care, and poor response to reassurance. This paper reviews the available literature for evidence to support these criteria, and evaluates if distinctive aspects of these characteristics exist in somatizers. METHODS The Pubmed database was searched combining terms such as “somatoform disorder” with “reassurance,” “satisfaction,” and “utilization.” Articles were individually inspected. RESULTS Many studies report a deficit in long-term response to reassurance in somatizers; there was some evidence that patients respond initially to reassurance, followed by return of anxiety, leading to further reassurance seeking. There was insufficient evidence to support poor satisfaction with care as a characteristic of somatizers. While there is no standard criterion for high utilization, regardless of definition, evidence was found to support over-utilization, particularly in outpatient visits. However, no unique pattern of utilization was found that could identify somatizers within a broader group of high utilizers. CONCLUSIONS This review revealed evidence of over-utilization in many areas of healthcare, as well as poor long term response to reassurance in somatizers. Dissatisfaction with care, though, was not a consistent finding. It is difficult to study alternative diagnostic criteria for somatoform patients when the current criteria rest on so many problematic assumptions. Future research should attempt to validate criteria empirically in patient groups, with selection not based on medically unexplained symptoms.
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Affiliation(s)
- Paul R Puri
- Department of Psychiatry, University of California, San Diego, CA, USA.
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Friedman SA, Phibbs CS, Schmitt SK, Hayes PM, Herrera L, Frayne SM. New Women Veterans in the VHA: A Longitudinal Profile. Womens Health Issues 2011; 21:S103-11. [DOI: 10.1016/j.whi.2011.04.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/20/2011] [Accepted: 04/20/2011] [Indexed: 10/28/2022]
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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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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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Gender Differences in Smoking and Smoking Cessation Treatment: An Examination of the Organizational Features Related to Care. Womens Health Issues 2011; 21:S182-9. [DOI: 10.1016/j.whi.2011.04.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/18/2011] [Accepted: 04/20/2011] [Indexed: 11/20/2022]
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Lynch CP, Strom JL, Egede LE. Effect of Veterans Administration use on indicators of diabetes care in a national sample of veterans. Diabetes Technol Ther 2010; 12:427-33. [PMID: 20470227 PMCID: PMC3690004 DOI: 10.1089/dia.2009.0171] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Diabetes poses a serious health burden, of which veterans have a disproportionate share. Few data exist regarding differences in self-care behaviors and provider-based quality of care indicators among a large sample of veterans. The objective of this study was to determine the effect of Veterans Affairs (VA) use on diabetes quality of care indicators among veterans. METHODS A cross-sectional analysis was done on data from 36,525 veterans in the 2003 Behavioral Risk Factor Surveillance Survey. VA use was defined as receiving some or all health care from a VA facility in the previous 12 months. Diabetes quality indicators such as two or more provider visits, two or more hemoglobin A1c tests, and flu and pneumonia shots were compared between VA users and non-VA users. The independent effect of VA use on each quality indicator was analyzed with multiple regression using STATA version 10 (Stata Press, College Station, TX) to account for the complex survey design and yield population estimates. RESULTS Among veterans with diabetes, 26.8% were VA users. The only significant difference between VA users and non-VA users was that VA users were significantly more likely to check their feet one or more times daily (75.7% vs. 68.5%, P = 0.015). In final adjusted models, VA users were at least twice as likely as non-VA users to have foot exams by a provider (odds ratio 2.59) and receive flu and pneumonia shots (odds ratio 2.30 and 2.05, respectively). VA users were also more likely to have two or more provider visits, dilated eye exams, and two or more hemoglobin A1c tests than non-VA users. CONCLUSIONS Key quality indicators for diabetes care were better among veterans getting some or all of their care from VA facilities, suggesting more effective care strategies. However, interventions should identify and perpetuate excellent self-care behaviors to more substantially impact adverse diabetes-related outcomes.
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Affiliation(s)
- Cheryl P Lynch
- Charleston VA Research Enhancement Award Program, Ralph H. Johnson Veteran Affairs Medical Center, Charleston, South Carolina 29456, USA.
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Haskell SG, Brandt CA, Krebs EE, Skanderson M, Kerns RD, Goulet JL. Pain among Veterans of Operations Enduring Freedom and Iraqi Freedom: do women and men differ? PAIN MEDICINE 2010; 10:1167-73. [PMID: 19818028 DOI: 10.1111/j.1526-4637.2009.00714.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate sex differences in the prevalence of overall pain, moderate-severe pain, and persistent pain among Veterans of Operations Enduring Freedom and Iraqi Freedom seen at VA outpatient clinics, and to evaluate sex differences in pain assessment. DESIGN The observational cohort consisted of Veterans discharged from the U.S. military from October 1, 2001 to November 30, 2007 that enrolled for Veterans Administration (VA) services or received VA care before January 1, 2008. We limited the sample to the 153,212 Veterans (18,481 female, 134,731 male) who had 1 year of observation after their last deployment. RESULTS Pain was assessed in 59.7% (n = 91,414) of Veterans in this sample. Among those assessed, 43.3% (n = 39,591) reported any pain, 63.2% (n = 25,028) of whom reported moderate-severe pain. Over 20% (n = 3,427) of Veterans with repeated pain measures reported persistent pain. We found no significant difference in the probability of pain assessment by sex (RR = 0.98, 95% CI 0.96, 1.00). Female Veterans were less likely to report any pain (RR 0.89, 95% CI 0.86, 0.92). Among those with any pain, female Veterans were more likely to report moderate-severe pain (RR 1.05, 95% CI 1.01, 1.09) and less likely to report persistent pain (RR 0.90, 95% CI 0.81, 0.99). CONCLUSIONS As the VA plans care for the increasing numbers of female Veterans returning from Iraq and Afghanistan, a better understanding of the prevalence of pain, as well as sex-specific variations in the experience and treatment of pain, is important for policy makers and providers who seek to improve identification and management of diverse pain disorders.
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Yano EM, Hayes P, Wright S, Schnurr PP, Lipson L, Bean-Mayberry B, Washington DL. Integration of women veterans into VA quality improvement research efforts: what researchers need to know. J Gen Intern Med 2010; 25 Suppl 1:56-61. [PMID: 20077153 PMCID: PMC2806960 DOI: 10.1007/s11606-009-1116-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Department of Veterans Affairs (VA) and other federal agencies require funded researchers to include women in their studies. Historically, many researchers have indicated they will include women in proportion to their VA representation or pointed to their numerical minority as justification for exclusion. However, women's participation in the military-currently 14% of active military-is rapidly changing veteran demographics, with women among the fastest growing segments of new VA users. These changes will require researchers to meet the challenge of finding ways to adequately represent women veterans for meaningful analysis. We describe women veterans' health and health-care use, note how VA care is organized to meet their needs, report gender differences in quality, highlight national plans for women veterans' quality improvement, and discuss VA women's health research. We then discuss challenges and potential solutions for increasing representation of women veterans in VA research, including steps for implementation research.
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Affiliation(s)
- Elizabeth M Yano
- VA Greater Los Angeles HSR&D Center of Excellence, 16111 Plummer Street, Sepulveda, CA 91343, USA.
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Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. J Gen Intern Med 2010; 25:18-24. [PMID: 19787409 PMCID: PMC2811589 DOI: 10.1007/s11606-009-1117-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 07/29/2009] [Accepted: 08/18/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients' use of non-mental health medical services and the impact of mental disorders on utilization. OBJECTIVE To compare utilization across three groups of Iraq and Afghanistan veterans: those without mental disorders, those with mental disorders other than PTSD, and those with PTSD. DESIGN AND PARTICIPANTS National, descriptive study of 249,440 veterans newly utilizing VA healthcare between October 7, 2001 and March 31, 2007, followed until March 31, 2008. MEASUREMENTS We used ICD9-CM diagnostic codes to classify mental health status. We compared utilization of outpatient non-mental health services, primary care, medical subspecialty, ancillary services, laboratory tests/diagnostic procedures, emergency services, and hospitalizations during veterans' first year in VA care. Results were adjusted for demographics and military service and VA facility characteristics. MAIN RESULTS Veterans with mental disorders had 42-146% greater utilization than those without mental disorders, depending on the service category (all P < 0.001). Those with PTSD had the highest utilization in all categories: 71-170% greater utilization than those without mental disorders (all P < 0.001). In adjusted analyses, compared with veterans without mental disorders, those with mental disorders other than PTSD had 55% higher utilization of all non-mental health outpatient services; those with PTSD had 91% higher utilization. Female sex and lower rank were also independently associated with greater utilization. CONCLUSIONS Veterans with mental health diagnoses, particularly PTSD, utilize significantly more VA non-mental health medical services. As more veterans return home, we must ensure resources are allocated to meet their outpatient, inpatient, and emergency needs.
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Gender disparities in Veterans Health Administration care: importance of accounting for veteran status. Med Care 2008; 46:549-53. [PMID: 18438204 DOI: 10.1097/mlr.0b013e3181608115] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In an effort to assess and reduce gender-related quality gaps, the Veterans Health Administration (VHA) has promoted gender-based research. Historically, such appraisals have often relied on secondary databases, with little attention to methodological implications of the fact that VHA provides care to some nonveteran patients. OBJECTIVES To determine whether conclusions about gender differences in utilization and cost of VHA care change after accounting for veteran status. DESIGN Cross-sectional. SUBJECTS All users of VHA in 2002 (N = 4,429,414). MEASURES Veteran status, outpatient/inpatient utilization and cost, from centralized 2002 administrative files. RESULTS Nonveterans accounted for 50.7% of women (the majority employees) but only 3.0% of men. Among all users, outpatient and inpatient utilization and cost were far lower in women than in men, but in the veteran subgroup these differences decreased substantially or, in the case of use and cost of outpatient care, reversed. Utilization and cost were very low among women employees; women spouses of fully disabled veterans had utilization and costs similar to those of women veterans. CONCLUSIONS By gender, nonveterans represent a higher proportion of women than of men in VHA, and some large nonveteran groups have low utilization and costs; therefore, conclusions about gender disparities change substantially when veteran status is taken into account. Researchers seeking to characterize gender disparities in VHA care should address this methodological issue, to minimize risk of underestimating health care needs of women veterans and other women eligible for primary care services.
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