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Taylor KA, Kapos FP, Sharpe JA, Kosinski AS, Rhon DI, Goode AP. Seventeen-Year National Pain Prevalence Trends Among U.S. Military Veterans. J Pain 2024; 25:104420. [PMID: 37952861 DOI: 10.1016/j.jpain.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023]
Abstract
U.S. military veterans experience higher pain prevalence than nonveterans. However, it is unclear how the disparities in pain prevalence have changed over time because previous trend studies are limited to veterans using the Veterans Health Administration. This repeated cross-sectional study aimed to characterize pain prevalence trends in the overall population of U.S. veterans compared to nonveterans, using nationally representative data. We analyzed 17 years of data from the National Health Interview Survey (2002-2018), with a mean annual unweighted sample of 29,802 U.S. adults (total unweighted n = 506,639) and mean annual weighted population of 229.7 million noninstitutionalized adults. The weighted proportion of veterans ranged from 11.48% in 2002 (highest) to 8.41% in 2017 (lowest). We found that veterans experience a similar or higher prevalence of pain than nonveterans across the study period, except for severe headaches or migraine and facial pain. Pain prevalence among veterans increased over time, with a higher rate of increase compared to nonveterans for all pain variables. From 2002 to 2018, there was an absolute increase (95% confidence interval) in pain prevalence among veterans (severe headache or migraine: 2.0% [1.6-2.4%]; facial pain: 1.9% [1.4-2.4%]; neck pain: 4.7% [4.1-5.2%]; joint pain: 11.4% [10.8-11.9%]; low back pain: 10.3% [9.5-11.1%]; any pain: 10.0% [9.6-10.4%]; and multiple pains: 9.9% [9.2-10.6%]). The continued pain prevalence increase among veterans may have implications for health care utilization, highlighting the need for improved pain prevention and care programs for this population with a disproportionate pain burden. PERSPECTIVE: This article uses routinely-collected cross-sectional data that are nationally representative of U.S. adults to present changes in pain prevalence among military veterans compared to nonveterans. The findings underscore the need for improved prevention and pain care programs for veterans, who experienced a widening disproportionate pain burden from 2002 to 2018.
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Affiliation(s)
- Kenneth Adam Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Flavia Penteado Kapos
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Jason Arthur Sharpe
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs (VA) Healthcare System, Durham, North Carolina
| | - Andrzej Stanislaw Kosinski
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Daniel I Rhon
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Adam Payne Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
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Butler S, Holt N, Dai F, Quick C, Kravetz JD, Perrino AC, Schonberger RB. Same-Day Primary Care Referral Versus Usual Care for Patients With Elevated Blood Pressures Seen in a Preoperative Clinic. Cureus 2024; 16:e58401. [PMID: 38756290 PMCID: PMC11098054 DOI: 10.7759/cureus.58401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background While several studies have suggested that anesthesia and surgical care episodes provide an opportunity to improve the diagnosis and treatment of hypertension, few studies have implemented and tested pragmatic care coordination efforts for this population. The present study aimed to examine the effects of same-day primary care referral vs. usual care on outpatient hypertension treatment among patients with elevated preoperative clinic blood pressure (BP). Methodology With institutional review board approval of the project as a quality improvement (QI) initiative not requiring consent, we conducted a prospective QI project comparing same-day preoperative primary care referral vs. usual care within comparable cohorts of US Veterans presenting to a preoperative evaluation clinic with elevated BP for whom treatment assignment was based on prior primary care clinic affiliation. Outpatient BP, antihypertensive medications, and antihypertensive dosages at the initial visit and for one year after the initial preoperative clinic visit were followed in the electronic health record. Results Between June 1, 2018, and June 1, 2019, one of the two on-site primary care groups (Firm A) at our facility agreed to accommodate same-day BP referrals. Patients in the second primary care group received standard preoperative care (Firm B). Charts for the pseudo-randomized cohort of Firm A and B patients were compared after 12 months to assess for changes in BP and hypertension treatment. Firm A and B patients were similar in demographics. Overall, 68 (91%) Firm A patients were correctly referred for primary care appointments. Moreover, 28 of 68 (41.2%) patients adhered to the same-day referral recommendation, with the remainder declining to attend the primary care visit. BPs were similar between Firm A and Firm B groups at 3, 6, 9, and 12 months post-intervention. Firm A adherent patients (i.e., those attending the referral) received hypertension treatment intensification sooner than Firm A non-adherent and Firm B patients (median (interquartile range) days to intensification = 21 (0.5-103.5) vs. 154 (45.5-239) and 170 (48-220), respectively; p = 0.038 and p = 0.048, respectively). Conclusions Our protocol achieved a high degree of same-day primary care referral (91%) in hypertensive patients presenting at the preoperative clinic. Although this limited study did not demonstrate improved BP control in patients who received same-day primary care, this group did show increased rates of rapid treatment intensification which may infer improved long-term health outcomes. Further work examining logistical barriers to patients attending same-day referrals is warranted.
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Affiliation(s)
- Shaunte Butler
- Anesthesiology and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Natalie Holt
- Anesthesiology, Indian Health Service, Aberdeen, USA
| | - Feng Dai
- Statistics, Yale School of Medicine, New Haven, USA
| | - Catherine Quick
- Anesthesiology, Veterans Affairs Connecticut Healthcare, West Haven, USA
| | - Jeffrey D Kravetz
- Primary Care, Yale School of Medicine, Veterans Affairs Connecticut Healthcare, West Haven, USA
| | - Albert C Perrino
- Anesthesiology, Yale School of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, USA
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Washington L, Bronson J, Timko C, Han B, Blue-Howells J, Finlay AK. Health Conditions and Treatment Utilization Among Older Male Veterans Incarcerated in Prisons. J Gen Intern Med 2024:10.1007/s11606-023-08587-5. [PMID: 38228986 DOI: 10.1007/s11606-023-08587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND More than 50,000 older male veterans incarcerated in prisons are expected to return to their communities and utilize the Veterans Health Administration (VHA) and community healthcare systems. To support the continuity of healthcare and overall successful community reentry of older incarcerated veterans, an understanding of their health profiles and treatment utilization while in correctional care is needed. OBJECTIVE To assess the health status of older male veterans incarcerated in state prisons and explore demographic, military, and VHA-related factors associated with medical conditions, disabilities, behavioral conditions, and medical and behavioral treatment utilization. DESIGN/PARTICIPANTS Cross-sectional observational study of 880 male veterans aged 50 + incarcerated in state prisons using data from the 2016 Bureau of Justice Statistics Survey of Prison Inmates. MAIN MEASURES Veteran status, self-report health status, and treatment utilization since prison admission. Prevalence rates for conditions and treatment utilization were calculated. Logistic regression models were used to examine the association of characteristics with conditions and treatment utilization. KEY RESULTS Among the 880 older male veterans in state prisons, the majority reported having a current medical condition (79.3%) or disability (61.6%), almost half had history of a mental health condition (44.5%), and more than a quarter (29%) had a substance use disorder. Compared to White veterans, Black veterans were less likely to report a disability or mental health condition. Few demographic, military, and VA-related characteristics were associated with medical or behavioral conditions or treatment utilization. CONCLUSION Our results suggest that the VHA and community healthcare systems need to be prepared to address medical and disability conditions among the majority of older male veterans who will be leaving prison and returning to their communities. Integrated medical and behavioral healthcare delivery models may be especially important for these veterans as many did not receive behavioral health treatment while in prison.
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Affiliation(s)
- Lance Washington
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA.
| | | | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
| | - Benjamin Han
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, San Diego, USA
- Veterans Affairs San Diego Healthcare System, San Diego, USA
| | - Jessica Blue-Howells
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
- National Center On Homelessness Among Veterans, Veterans Health Administration, Menlo Park, CA, USA
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Hammett PJ, Eliacin J, Saenger M, Allen KD, Meis LA, Krein SL, Taylor BC, Branson M, Fu SS, Burgess DJ. The Association Between Racialized Discrimination in Health Care and Pain Among Black Patients With Mental Health Diagnoses. J Pain 2024; 25:217-227. [PMID: 37591480 DOI: 10.1016/j.jpain.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
Chronic pain is a costly and debilitating problem in the United States, and its burdens are exacerbated among socially disadvantaged and stigmatized groups. In a cross-sectional study of Black Veterans with chronic pain at the Atlanta VA Health Care System (N = 380), we used path analysis to explore the roles of racialized discrimination in health care settings, pain self-efficacy, and pain-related fear avoidance beliefs as potential mediators of pain outcomes among Black Veterans with and without an electronic health record-documented mental health diagnosis. In unadjusted bivariate analyses, Black Veterans with a mental health diagnosis (n = 175) reported marginally higher levels of pain-related disability and significantly higher levels of pain interference compared to those without a mental health diagnosis (n = 205). Path analyses revealed that pain-related disability, pain intensity, and pain interference were mediated by higher levels of racialized discrimination in health care and lower pain self-efficacy among Black Veterans with a mental health diagnosis. Pain-related fear avoidance beliefs did not mediate pain outcomes. These findings highlight the need to improve the quality and effectiveness of health care for Black patients with chronic pain through the implementation of antiracism interventions within health care systems. Results further suggest that Black patients with chronic pain who have a mental health diagnosis may benefit from targeted pain management strategies that focus on building self-efficacy for managing pain. PERSPECTIVE: Racialized health care discrimination and pain self-efficacy mediated differences in pain-related disability, pain intensity, and pain interference among Black Veterans with and without a mental health diagnosis. Findings highlight the need for antiracism interventions within health care systems in order to improve the quality of care for Black patients with chronic pain. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01983228.
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Affiliation(s)
- Patrick J Hammett
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Johanne Eliacin
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael Saenger
- Anesthesia Service Line, Atlanta Veterans Administration Health Care System, Decatur, Georgia; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Veterans Affairs (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura A Meis
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sarah L Krein
- Center for Clinical Management Research, Veterans Affairs Healthcare System, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mariah Branson
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Steven S Fu
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Rose L, Tran D, Wu S, Dalton A, Kirsh S, Vashi A. Payer shifting after expansions in access to private care among veterans. Health Serv Res 2023; 58:1189-1197. [PMID: 37076113 PMCID: PMC10622298 DOI: 10.1111/1475-6773.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To investigate whether expanded access to Veterans Affairs (VA)-purchased care increased overall utilization or induced a shift from other payers to VA for emergency care among VA enrollees. DATA SOURCES AND STUDY SETTING This study included all emergency department (ED) encounters in 2019 from hospitals in the state of New York. STUDY DESIGN We conducted a difference-in-differences analysis comparing VA enrollees to the general population before and after the implementation of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act in June 2019. DATA COLLECTION/EXTRACTION METHODS We included all ED visits with individuals aged 30 or older at the time of the encounter. Individuals were considered eligible for the policy change if they were enrolled with VA at the beginning of 2019. PRINCIPAL FINDINGS Of the 5,577,199 ED visits in the sample, 4.9% (n = 253,799) were made by VA enrollees. Of these, 44.9% of visits were paid by Medicare, 32.8% occurred in VA facilities, and 7% were paid by private health insurance. There was a 6.4% (2.91 percentage points; std. error = 0.18; p < 0.01) decrease in the proportion of ED visits paid by Medicare among VA enrollees relative to the general population after the implementation of the MISSION Act in June 2019. This decrease was larger for ED visits with a subsequent inpatient admission (-8.4%; 4.87 percentage points; std. error = 0.33; p < 0.01). There was no statistically significant change in the total volume of ED visits (0.06%; std. error = 0.08; p = 0.45). CONCLUSIONS Leveraging a novel dataset, we demonstrate that MISSION Act implementation coincided with a shift in the financing of non-VA ED visits from Medicare to VA without any increase in overall ED utilization. These findings have important implications for VA health care financing and delivery.
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Affiliation(s)
- Liam Rose
- Department of Veterans AffairsHealth Economics Resource CenterMenlo ParkCaliforniaUSA
- Stanford Surgery Policy Improvement Research and Education (S‐SPIRE) CenterStanford UniversityStanfordCaliforniaUSA
| | - Diem Tran
- Department of Veterans AffairsHealth Economics Resource CenterMenlo ParkCaliforniaUSA
- Stanford Surgery Policy Improvement Research and Education (S‐SPIRE) CenterStanford UniversityStanfordCaliforniaUSA
| | - Siqi Wu
- Stanford Primary Care and Population HealthStanford UniversityStanfordCaliforniaUSA
| | - Aaron Dalton
- Department of Veterans AffairsCenter for Innovation to ImplementationMenlo ParkCaliforniaUSA
| | - Susan Kirsh
- Department of Veterans AffairsActing Deputy Assistant Undersecretary for Health for Discovery Education and Affiliated NetworksWashingtonDCUSA
| | - Anita Vashi
- Department of Veterans AffairsCenter for Innovation to ImplementationMenlo ParkCaliforniaUSA
- Department of Emergency MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Phillips KK, Mecca MC, Baim-Lance AM, Schiller GS, Pruskowski JA, Ellis EC, Aponte-Rosario DS, Federovich-Hogan AL, Kossifologos AC, Martinez ED, Boockvar KS. A virtual breakthrough series collaborative to support deprescribing interventions across Veterans Affairs healthcare settings. J Am Geriatr Soc 2023; 71:2935-2945. [PMID: 37337658 DOI: 10.1111/jgs.18474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/04/2023] [Accepted: 05/27/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Virtual collaborative models are a practical way to implement a supportive environment for multi-team learning. In this project, we aimed to describe the processes and outcomes of a virtual deprescribing collaborative that facilitated implementation of deprescribing interventions around the country. METHODS Two successive cohorts comprised of multidisciplinary teams from geographically diverse veterans affairs (VA) sites were selected via an application process to participate in a virtual deprescribing collaborative. Each site developed its own deprescribing protocol and took part in regular meetings, mentoring groups, monthly data reporting, and other learning activities over an approximate 9 month period, per cohort. Standard measures were number of veterans served and medications deprescribed. Descriptive and qualitative analyses were utilized. RESULTS Twenty-one total VA sites were selected to participate in the deprescribing collaborative in two cohorts (Cohort 1, n = 12 sites; Cohort 2, n = 9 sites). The majority of sites' practice areas directly served the older adult population, and the majority of site leads were pharmacists. The most utilized tool used by the collaborative sites was the VA VIONE decision support tool (n = 14) and the most common strategy was individualized medication review. Combining outcomes from both Cohorts 1 and 2, a total of n = 4770 veterans were served, with 8332 medications deprescribed. Eighty-two percent of Cohort 1 sites surveyed reported their deprescribing program was still being utilized after 1 year follow up. CONCLUSIONS This virtual deprescribing collaborative aided in the successful implementation of both established and novel deprescribing practices across a variety of VA practice sites that care for older adults. The shared learning experience enhanced problem solving and allowed for interdisciplinary teamwork. Overall the collaborative was successful in improving polypharmacy for several thousand older adults.
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Affiliation(s)
- Kristin K Phillips
- Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Marcia C Mecca
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Abigail M Baim-Lance
- Geriatric Research, Education, and Clinical Center (GRECC), James J Peters Bronx VA Medical Center, Bronx, NY, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabrielle S Schiller
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Jennifer A Pruskowski
- Geriatric Research, Education, and Clinical Center (GRECC), Pittsburgh Veteran Affairs Healthcare System, Pittsburgh, PA, USA
- Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | | | - Amanda L Federovich-Hogan
- Geriatric Research, Education, and Clinical Center (GRECC), Pittsburgh Veteran Affairs Healthcare System, Pittsburgh, PA, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Erica D Martinez
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Kenneth S Boockvar
- Department of Medicine-Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham VA Health Care System, Birmingham, AL, USA
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C. Coleman B, Finch D, Wang R, L. Luther S, Heapy A, Brandt C, J. Lisi A. Extracting Pain Care Quality Indicators from U.S. Veterans Health Administration Chiropractic Care Using Natural Language Processing. Appl Clin Inform 2023; 14:600-608. [PMID: 37164327 PMCID: PMC10411229 DOI: 10.1055/a-2091-1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Musculoskeletal pain is common in the Veterans Health Administration (VHA), and there is growing national use of chiropractic services within the VHA. Rapid expansion requires scalable and autonomous solutions, such as natural language processing (NLP), to monitor care quality. Previous work has defined indicators of pain care quality that represent essential elements of guideline-concordant, comprehensive pain assessment, treatment planning, and reassessment. OBJECTIVE Our purpose was to identify pain care quality indicators and assess patterns across different clinic visit types using NLP on VHA chiropractic clinic documentation. METHODS Notes from ambulatory or in-hospital chiropractic care visits from October 1, 2018 to September 30, 2019 for patients in the Women Veterans Cohort Study were included in the corpus, with visits identified as consultation visits and/or evaluation and management (E&M) visits. Descriptive statistics of pain care quality indicator classes were calculated and compared across visit types. RESULTS There were 11,752 patients who received any chiropractic care during FY2019, with 63,812 notes included in the corpus. Consultation notes had more than twice the total number of annotations per note (87.9) as follow-up visit notes (34.7). The mean number of total classes documented per note across the entire corpus was 9.4 (standard deviation [SD] = 1.5). More total indicator classes were documented during consultation visits with (mean = 14.8, SD = 0.9) or without E&M (mean = 13.9, SD = 1.2) compared to follow-up visits with (mean = 9.1, SD = 1.4) or without E&M (mean = 8.6, SD = 1.5). Co-occurrence of pain care quality indicators describing pain assessment was high. CONCLUSION VHA chiropractors frequently document pain care quality indicators, identifiable using NLP, with variability across different visit types.
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Affiliation(s)
- Brian C. Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Dezon Finch
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
| | - Rixin Wang
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Stephen L. Luther
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida, United States
- College of Public Health, University of South Florida, Tampa, Florida, United States
| | - Alicia Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Cynthia Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Anthony J. Lisi
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale Center for Medical Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
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Murphy KS, Atkinson DM, Starks J. The Importance of Person-Centered Approaches to Managing Behavioral and Psychological Symptoms of Dementia: A Case Report. Cureus 2023; 15:e37387. [PMID: 37182008 PMCID: PMC10171880 DOI: 10.7759/cureus.37387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are common and associated with increased morbidity and mortality in dementia. In this report, we describe a patient with severe BPSD who was effectively managed with a variety of non-pharmacologic strategies. A 70-year-old Navy veteran and retired commercial flooring business owner with a history of dementia was admitted to the hospital with aggressive behavior. He was no longer manageable by his family. He required intermittent use of restraints and multiple antipsychotics during hospitalization. He spent much of his time crawling on the floor, "working" on floor tiles, which was often difficult for staff to safely accommodate. However, with time, interprofessional staff identified signs of distress and developed strategies to safely engage the patient's current perception of his situation. This case highlights how BPSD may be driven by a person's identities and roles from earlier stages of life. Approaching and managing these symptoms flexibly can enhance dementia care.
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Affiliation(s)
- Kayla S Murphy
- Psychiatry, University of Minnesota, Minneapolis, USA
- Psychiatry, The University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - David M Atkinson
- Psychiatry/Geriatric Psychiatry, Minneapolis Veterans Affairs (VA) Health Care System, Minneapolis, USA
- Psychiatry/Geriatric Psychiatry, University of Minnesota, Minneapolis, USA
| | - Jamie Starks
- Neurology/Behavioral Neurology, Minneapolis Veterans Affairs (VA) Health Care System, Minneapolis, USA
- Neurology/Behavioral Neurology, University of Minnesota, Minneapolis, USA
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Akwe J, Hall MAK. Primary Care Considerations for Elderly U.S. Veterans of World War II and the Korean War: A Narrative Review. Cureus 2023; 15:e37309. [PMID: 37182054 PMCID: PMC10166705 DOI: 10.7759/cureus.37309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 05/16/2023] Open
Abstract
Many of the United States' more than 18 million veterans obtain healthcare through the Department of Veterans Affairs' (VA) Veterans Health Administration system; however, recent legislative changes have expanded veterans' access to non-VA care in their communities, particularly for those who do not live near VA medical centers. Veterans are seen by physicians in outpatient practice across the United States and are admitted to non-VA hospitals; this is particularly salient for older veterans, who may require a more frequent and high level of care. We present a review of characteristics of U.S. veterans from two conflicts: World War II (WWII) and the Korean War. While non-VA clinicians are well equipped to provide care for patients of all different ages, veterans of armed conflicts have a unique constellation of exposures and cultural considerations that must be accounted for when providing them care. In this review, we describe characteristics of the generations of American veterans who served in WWII and the Korean War conflicts in a brief historical context. We then note conflict-specific exposures and potential long-term sequelae to watch for during physical examinations and to monitor thereafter, age-specific health and emotional concerns, and best practices for providing care to this cohort of veterans.
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Affiliation(s)
- Joyce Akwe
- Hospital Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, USA
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Dryden EM, Kennedy MA, Conti J, Boudreau JH, Anwar CP, Nearing K, Pimentel CB, Hung WW, Moo LR. Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers. Health Serv Res 2023; 58 Suppl 1:26-35. [PMID: 36054487 PMCID: PMC9843069 DOI: 10.1111/1475-6773.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value. DATA SOURCES In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits. STUDY DESIGN A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges. DATA COLLECTION We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach. PRINCIPAL FINDINGS Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity). CONCLUSIONS Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.
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Affiliation(s)
- Eileen M. Dryden
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Family MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Jennifer Conti
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Chitra P. Anwar
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Kathryn Nearing
- Eastern Colorado VA Geriatric Research Education and Clinical CenterAuroraColoradoUSA,Division of Geriatric MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Camilla B. Pimentel
- Center for Healthcare Organization and Implementation ResearchDepartment of Veterans Affairs (VA) Bedford Healthcare SystemBedfordMassachusettsUSA,New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of Public Health, Zuckerberg College of Health SciencesUniversity of Massachusetts LowellLowellMassachusettsUSA
| | - William W. Hung
- Bronx Geriatric Research Education and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA,Department of Geriatrics and Palliative MedicineIcahn School of MedicineNew York CityNew YorkUSA
| | - Lauren R. Moo
- New England Geriatric Research, Education, and Clinical CenterVA Bedford Healthcare SystemBedfordMassachusettsUSA,Department of NeurologyHarvard Medical SchoolBostonMassachusettsUSA
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11
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Neslusan C, Chopra I, Joshi K, Voelker J. Clinical and economic burden of major depressive disorder with acute suicidal ideation or behavior in a US Veterans Health Affairs database. Curr Med Res Opin 2022; 38:1603-1611. [PMID: 35670276 DOI: 10.1080/03007995.2022.2081452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Although a high incidence of major depressive disorder (MDD) and an increased risk of suicide are observed among the veteran population, there are yet limited real-world data characterizing patients with MDD with acute suicidal ideation/behavior (MDSI) in the Veterans Health Administration (VHA) system. We assessed the clinical and economic burden, including comorbidities, treatment patterns, health care resource utilization, and health care costs, among veterans and their family members with MDSI within the VHA system. METHODS This retrospective, longitudinal analysis of VHA datasets (10/1/2015-3/31/2018) evaluated the clinical and economic burden associated with MDSI and compared this population with matched MDD alone (i.e. MDD diagnosis without acute suicidal ideation/behavior) and non-MDD (i.e. neither MDD nor acute suicidal ideation/behavior) cohorts. RESULTS Among 11,203 patients with MDSI, the proportions of patients who filled a prescription for ≥1 antidepressant during the 12-month pre- and 6-month post-periods were significantly higher compared with patients with MDD alone (53.7% vs 28.8%, p < .05; and 72.3% vs 44.1%, p < .05; respectively). During the 12-month pre-period, the MDSI cohort had the highest proportion of patients with ≥1 mental health-related inpatient visit compared with the MDD alone and non-MDD cohorts (13.2% vs 2.3% vs 1.4%, respectively; p < .05), and the highest mental health-related costs per patient ($8853 vs $1913 vs $1079, respectively). For the 6-month post-period, the MDSI cohort had the highest proportion of patients with ≥1 mental health-related inpatient visit compared with the MDD alone and non-MDD cohorts (60.4% vs 7.9% vs 0.8%, respectively; p < .05), and had the highest mental health-related costs per patient ($20,334 vs $4803 vs $545, respectively). CONCLUSIONS Findings demonstrate significant clinical and economic burden for those in the VHA system diagnosed with MDSI and highlight unmet needs and opportunities for improving the care of this vulnerable group.
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Affiliation(s)
| | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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12
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Abstract
PURPOSE Disparities in the treatment of posttraumatic stress disorder (PTSD) for rural veterans have been noted in prior research. The objective was to examine rural differences in prescribing for veterans with PTSD, and changes over time, in the Department of Veterans Affairs (VA) health care system. METHODS Prescribing prevalence in veterans with PTSD during 2009 and 2019 was determined using national VA administrative pharmacy data according to the joint VA-Department of Defense clinical practice guideline as medications recommended for use in PTSD and those recommended against use. Multivariable logistic regression was used to contrast patient residence (urban vs rural) and site of PTSD care (medical center, urban clinic, or rural clinic), while adjusting for clinical covariates. FINDINGS Recommended medications were prescribed significantly less often to patients of rural clinics, relative to medical centers in 2009 (OR = 0.91; 95% CI: 0.89-0.94) but reached equivalence in 2019 (OR = 1.01; 95% CI: 0.99-1.03). In addition, rural clinics had significantly lower prescribing of recommended against medications (OR = 0.86; 95% CI: 0.84-0.87) in 2019. Prescribing of medications recommended against the use for PTSD was higher among rural residents, relative to urban residents in 2009 (OR = 1.14; 95% CI: 1.12-1.16), which declined toward equivalence by 2019 (OR = 1.06; 95% CI: 1.05-1.07). CONCLUSIONS While some clinically meaningful differences in prescribing for rural veterans with PTSD were observed in 2009, these differences shifted toward equivalency within the following decade. In 2019, we failed to observe any systematic prescribing deficiencies for veterans receiving PTSD care at rural clinics.
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Affiliation(s)
- Brian C Lund
- Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Nancy C Bernardy
- Research Department, White River Junction VA Medical Center, White River Junction, Vermont, USA.,National Center for PTSD, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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13
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Schleiden LJ, Zickmund SL, Roman KL, Kennedy K, Thorpe JM, Rossi MI, Niznik JD, Springer SP, Thorpe CT. Caregiver and provider perspectives on dual VA and Medicare Part D medication use in veterans with suspected dementia or cognitive impairment. Am J Health Syst Pharm 2021; 79:94-101. [PMID: 34453437 DOI: 10.1093/ajhp/zxab343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Many older veterans with dementia fill prescriptions through both Veterans Affairs (VA) and Medicare Part D benefits. Dual VA/Part D medication use may have unintended negative consequences on prescribing safety and quality. We aimed to characterize benefits and drawbacks of dual VA/Part D medication use in veterans with dementia or cognitive impairment from the perspectives of caregivers and providers. METHODS This was a qualitative study based on semistructured telephone interviews of 2 group: (1) informal caregivers accompanying veterans with suspected dementia or cognitive impairment to visits at a VA Geriatric Evaluation and Management clinic (n = 11) and (2) VA healthcare providers of veterans with dementia who obtained medications via VA and Part D (n = 12). We conducted semistructured telephone interviews with caregivers and providers about benefits and drawbacks of dual VA/Part D medication use. Interview transcripts were subjected to qualitative content analysis to identify key themes. RESULTS Caregivers and providers both described cost and convenience benefits to dual VA/Part D medication use. Caregivers reported drawbacks including poor communication between VA and non-VA providers and difficulty managing medications from multiple systems. Providers reported potential safety risks including communication barriers, conflicting care decisions, and drug interactions. CONCLUSION Results of this study allow for understanding of potential policy interventions to better manage dual VA/Part D medication use for older veterans with dementia or cognitive impairment at a time when VA is expanding access to non-VA care.
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Affiliation(s)
- Loren J Schleiden
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Susan L Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, UT, and Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katie Lynn Roman
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Kayla Kennedy
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Joshua M Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Michelle I Rossi
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, and Division of Geriatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joshua D Niznik
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Sydney P Springer
- University of New England School of Pharmacy Westbrook College of Health Professions, Portland, ME, USA
| | - Carolyn T Thorpe
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, and Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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14
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Franzosa E, Traylor M, Judon KM, Guerrero Aquino V, Schwartzkopf AL, Boockvar KS, Dixon BE. Perceptions of event notification following discharge to improve geriatric care: qualitative interviews of care team members from a 2-site cluster randomized trial. J Am Med Inform Assoc 2021; 28:1728-1735. [PMID: 33997903 DOI: 10.1093/jamia/ocab074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess primary care teams' perceptions of a health information exchange (HIE) event notification intervention for geriatric patients in 2 Veterans Health Administration (VHA) medical centers. MATERIALS AND METHODS We conducted a qualitative evaluation of an event notification alerting primary care teams to non-VHA hospital admissions and emergency department visits. Data were collected through semistructured interviews (n = 23) of primary care team physicians, nurses and medical assistants. Study design and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Team members found the alerts necessary, helpful for filling information gaps, and effective in supporting timely follow-up care, although some expressed concern over scheduling capacity and distinguishing alerts from other VHA notices. Participants also suggested improvements including additional data on patients' diagnosis and discharge instructions, timing alerts to patients' discharge (including clear next steps), including additional team members to ensure alerts were acted upon, and implementing a single sign-on. DISCUSSION Primary care team members perceived timely event notification of non-VHA emergency department visits and hospital admissions as potentially improving post-discharge follow-up and patient outcomes. However, they were sometimes unsure of next steps and suggested the alerts and platform could be streamlined for easier use. CONCLUSIONS Event notifications may be a valuable tool in coordinating care for high-risk older patients. Future intervention research should explore the optimal amount and types of information and delivery method across sites and test the integration of alerts into broader care coordination efforts.
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Affiliation(s)
- Emily Franzosa
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Morgan Traylor
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - Kimberly M Judon
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Vivian Guerrero Aquino
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ashley L Schwartzkopf
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - Kenneth S Boockvar
- Geriatric Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian E Dixon
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
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15
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Sherman RL, Judon KM, Koufacos NS, Guerrero Aquino VM, Raphael SM, Hollander JT, Boockvar KS. Utilizing a health information exchange to facilitate COVID-19 VA primary care follow-up for Veterans diagnosed in the community. JAMIA Open 2021; 4:ooab020. [PMID: 33748690 PMCID: PMC7962785 DOI: 10.1093/jamiaopen/ooab020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/22/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
The use of alerts from the Bronx RHIO, a health information exchange (HIE) to identify James J. Peters VAMC patients diagnosed with COVID-19 in the community was described to facilitate COVID-19 VA primary care follow-up. COVID-19 hospitalization and testing alerts were delivered on a Bronx RHIO facility report. VA COVID-19 follow-up care by telephone and video was guided by local COVID-19 clinical pathways, electronic health record (EHR) templates, and tracking through a database. VA received 180 RHIO alerts for 111 unique patients, and 88 had positive non-VA testing from March to June 2020. 41% of the 88 had non-VA admissions and 23% died. 63% received VA primary care follow-up of COVID-19 symptoms documented by custom EHR templates. The HIE identified 11% of the facility COVID-19 patients. HIE alerts can be used to identify facility COVID-19 patients diagnosed in the community and facilitate follow-up by their VA primary care teams.
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Affiliation(s)
- Rachel L Sherman
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Kimberly M Judon
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Nicholas S Koufacos
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | | | - Shaniqua M Raphael
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Judith T Hollander
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
| | - Kenneth S Boockvar
- Department of Veterans Affairs, James J. Peters Medical Center, Bronx, New York, USA
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16
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Stewart IJ, Poltavskiy E, Howard JT, Janak JC, Pettey W, Zarzabal LA, Walker LE, Beyer CA, Sim A, Suo Y, Redd A, Chung KK, Gundlapalli A. The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease. J Gen Intern Med 2021; 36:713-21. [PMID: 32959346 DOI: 10.1007/s11606-020-06195-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND A better understanding of the long-term health effects of combat injury is important for the management of veterans' health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. OBJECTIVE To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. DESIGN Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. PARTICIPANTS Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. MAIN MEASURES Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. KEY RESULTS After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18-3.55), DM (HR 4.45, 95% CI 2.15-9.18), and CAD (HR 4.87, 95% CI 2.11-11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05-1.24) and CAD (HR 1.62, 95% CI 1.11-2.37). CONCLUSIONS Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.
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17
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Gibson-Gill CM, Williams J, Fyffe D. Triangle of Healthy Caregiving for Veterans With Spinal Cord Injury: Proposal for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e14051. [PMID: 32396130 PMCID: PMC7251480 DOI: 10.2196/14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background Spinal cord injury (SCI) is a debilitating injury that results in chronic paralysis, impaired functioning, and drastically altered quality of life (QOL). The Department of Veterans Affairs (VA) estimates that approximately 450 newly injured veterans and active-duty members receive rehabilitation at VA’s Spinal Cord Injury/Disorders Centers annually. VA virtual health services use technology and health informatics to provide veterans with better access and more effective care management. The “Triangle of Healthy Caregiving for SCI Veterans” is a patient-centered intervention that incorporates SCI veterans’ caregivers into the VA SCI health care team and extends into the homes of veterans with SCI by using real-time clinical video teleconferencing (CVT). CVT facilitates video-clinic visits, which can include different types of clinical evaluations, therapy (physical/occupational), or psychosocial services. The “Triangle of Healthy Caregiving for SCI Veterans” builds on interactive, interdisciplinary health care relationships that exist between the veterans with SCI, their caregivers, and the VA SCI health care team. SCI veterans’ propensity to multiple secondary complications makes a healthy partnership crucial for the success of keeping better health and functional outcomes as well as quality of life while living in their homes. Objective The goal of the proposed mixed methods project will assess SCI veterans’, their caregivers’, and the VA health care team’s perspectives and experiences in the “Triangle of Healthy Caregiving for SCI Veterans” to determine the benefits, challenges, and outcomes for everyone involved in the intervention. Methods Data collection methods will be implemented over three sequential phases. First, in-depth interviews will be conducted with the telehealth coordinators to systematically document the administrative procedures involved in enrollment of veterans with SCI into the CVT system. Next, structured observation of the CVT enrollment process and logistics of home installation of the CVT system will be conducted to validate the content of the in-depth interviews and highlight any discrepancies observed. Semistructured interviews will be conducted to assess specific elements of the “Triangle of Healthy Caregiving for SCI Veterans” program, their perceived utility, and effectiveness of the CVT system as well as the general impressions of the impact of the intervention on the SCI veterans’ health and function outcomes, caregiver burden, and daily caregiver burden. Finally, the research team will conduct a focus group to evaluate the ways in which the “Triangle of Healthy Caregiving for SCI Veterans” is useful for health care delivery to veterans with SCI and support services to SCI caregivers. Results This proposal was funded in July 2017. It was reviewed and received institutional review board approval in March 2018, and the project was started immediately after, in the same month. As of September 2019, we have completed Phases I and III and have recruited 52 subjects for Phase II. We are beginning the data analysis. The study is projected to be completed in late summer of 2020, and the expected results are to be published in the fall of 2020. Conclusions The findings from this study will highlight the ways in which virtual health care technologies can be used to improve access to SCI specialized care for veterans and provide an estimation of the potential impact on clinical outcomes for veterans with SCI and their caregivers. International Registered Report Identifier (IRRID) DERR1-10.2196/14051
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Affiliation(s)
- Carol McMara Gibson-Gill
- Veterans Administration, New Jersey Health Care System, East Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Joyce Williams
- Veterans Administration, New Jersey Health Care System, East Orange, NJ, United States
| | - Denise Fyffe
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States.,Kessler Foundation, West Orange, NJ, United States
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18
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Trail T, Friedman E, Rutter CM, Tanielian T. The Relationship Between Engagement in Online Support Groups and Social Isolation Among Military Caregivers: Longitudinal Questionnaire Study. J Med Internet Res 2020; 22:e16423. [PMID: 32324141 PMCID: PMC7206524 DOI: 10.2196/16423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/31/2020] [Accepted: 02/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a lack of research on the effectiveness of online peer support groups for reducing social isolation and depressive symptoms among caregivers, and previous research has mixed results. OBJECTIVE This study aimed to test whether military caregivers who joined a new online peer support community or engaged with an existing online community experienced decreased perceived social isolation and improved depressive symptoms over 6 months. METHODS We conducted a longitudinal study of 212 military caregivers who had newly joined an online community and those who were members of other military caregiver groups. Multiple indicators of perceived social isolation and depressive symptoms were assessed at baseline and at 3 and 6 months. RESULTS Compared with caregivers in the comparison group, caregivers who joined the new group experienced less perceived social isolation at 3 months (eg, number of caregivers in social network [unstandardized regression coefficients] b=0.49, SE 0.19, 95% CI 0.87 to 0.02), but this effect did not persist at 6 months. Those who engaged more with new or existing groups experienced less perceived social isolation over time (eg, number of caregivers in social network b=0.18, SE 0.06, 95% CI 0.02 to 0.27), and this relationship was mediated by increased interactions with other military caregivers (95% CI 0.0046 to 0.0961). Engagement with an online group was not associated with improvements in depressive symptoms. CONCLUSIONS Online communities might help reduce social isolation when members engage with the group, but more intensive treatment is needed to improve depressive symptoms.
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19
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Song S, Thomas IC, Ganesan C, Sohlberg EM, Chertow GM, Liao JC, Conti S, Elliott CS, Pao AC, Leppert JT. Twenty-Four Hour Urine Testing and Prescriptions for Urinary Stone Disease-Related Medications in Veterans. Clin J Am Soc Nephrol 2019; 14:1773-1780. [PMID: 31712387 PMCID: PMC6895498 DOI: 10.2215/cjn.03580319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current guidelines recommend 24-hour urine testing in the evaluation and treatment of persons with high-risk urinary stone disease. However, how much clinicians use information from 24-hour urine testing to guide secondary prevention strategies is unknown. We sought to determine the degree to which clinicians initiate or continue stone disease-related medications in response to 24-hour urine testing. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We examined a national cohort of 130,489 patients with incident urinary stone disease in the Veterans Health Administration between 2007 and 2013 to determine whether prescription patterns for thiazide diuretics, alkali therapy, and allopurinol changed in response to 24-hour urine testing. RESULTS Stone formers who completed 24-hour urine testing (n=17,303; 13%) were significantly more likely to be prescribed thiazide diuretics, alkali therapy, and allopurinol compared with those who did not complete a 24-hour urine test (n=113,186; 87%). Prescription of thiazide diuretics increased in patients with hypercalciuria (9% absolute increase if urine calcium 201-400 mg/d; 21% absolute increase if urine calcium >400 mg/d, P<0.001). Prescription of alkali therapy increased in patients with hypocitraturia (24% absolute increase if urine citrate 201-400 mg/d; 34% absolute increase if urine citrate ≤200 mg/d, P<0.001). Prescription of allopurinol increased in patients with hyperuricosuria (18% absolute increase if urine uric acid >800 mg/d, P<0.001). Patients who had visited both a urologist and a nephrologist within 6 months of 24-hour urine testing were more likely to have been prescribed stone-related medications than patients who visited one, the other, or neither. CONCLUSIONS Clinicians adjust their treatment regimens in response to 24-hour urine testing by increasing the prescription of medications thought to reduce risk for urinary stone disease. Most patients who might benefit from targeted medications remain untreated.
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Affiliation(s)
- Shen Song
- Division of Nephrology, Departments of Medicine and
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
| | | | - Ericka M Sohlberg
- Urology, Stanford University School of Medicine, Stanford, California
| | | | - Joseph C Liao
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Urology, Stanford University School of Medicine, Stanford, California
| | - Simon Conti
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Urology, Stanford University School of Medicine, Stanford, California
| | - Christopher S Elliott
- Urology, Stanford University School of Medicine, Stanford, California.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California
| | - Alan C Pao
- Division of Nephrology, Departments of Medicine and.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Urology, Stanford University School of Medicine, Stanford, California
| | - John T Leppert
- Division of Nephrology, Departments of Medicine and.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Urology, Stanford University School of Medicine, Stanford, California
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Vandenberg AE, Echt KV, Kemp L, McGwin G, Perkins MM, Mirk AK. Academic Detailing with Provider Audit and Feedback Improve Prescribing Quality for Older Veterans. J Am Geriatr Soc 2019. [PMID: 29532466 DOI: 10.1111/jgs.15247] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Suboptimal prescribing persists as a driver of poor quality care of older veterans and is associated with risk of hospitalization and emergency department visits. We adapted a successful medication management model, Integrated Management and Polypharmacy Review of Vulnerable Elders (IMPROVE), from an urban geriatric specialty clinic to rural community-based clinics that deliver primary care. The goals were to promote prescribing quality and safety for older adults, including reduced prescribing of potentially inappropriate medications (PIMs). We augmented the original model, which involved a pharmacist-led, one-on-one medication review with high-risk older veterans, to provide rural primary care providers (PCPs) and pharmacists with educational outreach through academic detailing and tools to support safe geriatric prescribing practices, as well as individual audit and feedback on prescribing practice and confidential peer benchmarking. Twenty PCPs and 4 pharmacists at 4 rural Georgia community-based outpatient clinics participated. More than 7,000 older veterans were seen in more than 20,000 PCP encounters during the 14-month intervention period. Implementation of the IMPROVE intervention reduced PIM prescribing incidence from 9.6 new medications per 100 encounters during baseline to 8.7 after the intervention (P = .009). IMPROVE reduced PIM prevalence (proportion of encounters involving veterans who were taking at least 1 PIM) from 22.6% to 16.7% (P < .001). These approaches were effective in reducing PIMs prescribed to older veterans in a rural setting and constitute a feasible model for disseminating geriatric best practices to the primary care setting.
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Affiliation(s)
- Ann E Vandenberg
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Decatur, Georgia.,Division of General Medicine and Geriatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Katharina V Echt
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Decatur, Georgia.,Division of General Medicine and Geriatrics, School of Medicine, Emory University, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Lawanda Kemp
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Gerald McGwin
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Decatur, Georgia
| | - Molly M Perkins
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Decatur, Georgia.,Division of General Medicine and Geriatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Anna K Mirk
- Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center, Decatur, Georgia.,Division of General Medicine and Geriatrics, School of Medicine, Emory University, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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21
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Wyte-Lake T, Der-Martirosian C, Claver M, Davis D, Dobalian A. Provider Delivery of Emergency Preparedness Education in Home-Based Primary Care. Disaster Med Public Health Prep 2019; 13:547-554. [PMID: 30378517 PMCID: PMC6494722 DOI: 10.1017/dmp.2018.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACTIntroductionHome health agencies have been tasked to improve their patients' disaster preparedness. Few studies have evaluated the robustness of tools to support preparedness in home health. Through evaluation of the Home-Based Primary Care (HBPC) Patient Assessment Tool, we conducted a survey to identify strengths and challenges in supporting the preparedness of patients served by home health programs such as the Veterans Health Administration's HBPC program. METHODS: Practitioners from 10 HBPC programs fielded the Patient Assessment Tool with all patients during a 3-week period. Logistic regression and bivariate analyses were used to identify patient characteristics associated with the delivery of preparedness education. RESULTS: A total of 754 Patient Assessment Tools were returned. The educational item most likely to be covered was how to activate 911 services (87%). The item least likely to be discussed was information on emergency shelter registration and emergency specialty transportation (44%). When compared to the low risk group, HBPC patients in the high/medium risk group were more likely to receive preparedness education materials for 6 of the 9 educational preparedness items (P values less than 0.05).DiscussionPractitioners are relaying preparedness education to their most vulnerable patients, suggesting that home health agencies can provide disaster preparedness in the home. Nonetheless, there is room for improvement. (Disaster Med Public Health Preparedness. 2019;13:547-554).
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Affiliation(s)
- Tamar Wyte-Lake
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), 16111 Plummer St. MS-152, North Hills, CA 91343, P: (818) 891-7711 ext. 36100 F: (818) 895-5838
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA)
| | - Maria Claver
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Gerontology Program, California State University, Long Beach, CA
| | - Darlene Davis
- Geriatrics and Extended Care, Home and Community Based Care, U.S. Department of Veterans Affairs (VA)
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center (VEMEC), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN
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22
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Presley CA, Byerly SH, Aylor AR, Mixon AS. An environmental scan of medication history technician programs within the Veterans Health Administration. Am J Health Syst Pharm 2019; 76:44-49. [PMID: 31603983 DOI: 10.1093/ajhp/zxy005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Results of a study to identify medication history technician (MHT) programs within the Veterans Health Administration (VHA) and to evaluate the personnel, structure, and scope of such programs are reported. METHODS Specially trained pharmacy technicians can take accurate patient medication histories and contribute to the medication reconciliation process. An environmental scan of MHT programs within VHA was conducted via an email query of pharmacy personnel. Semistructured interviews of personnel at each responding site (an MHT, a pharmacist, or both) were conducted. RESULTS Ten VHA sites had existing MHT programs; the earliest was initiated in 2010. Sites employed from 1 to 4 MHTs, who most commonly worked in the inpatient setting (7 sites). At most sites (9), MHTs obtained a "best possible medication history" through systematic collection of medication information using 2 reliable sources, such as patients, caregivers, and medical records. Survey respondents at all sites reported benefits of MHT programs, including dedicated time to obtain medication histories, allowing for more effective use of pharmacists' time. Six sites were eager to increase the reach of their programs. MHT training, oversight, and quality assurance varied across the sites. The survey results indicated that there are opportunities nationally-within and outside VHA-to develop standardized training, competency assessments, and quality assurance measures for MHT programs. CONCLUSION Ten VHA sites with MHT programs were identified. MHTs most commonly worked in inpatient settings as part of admission medication reconciliation processes.
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Affiliation(s)
- Caroline A Presley
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Susan H Byerly
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Amy R Aylor
- VA Office of Strategic Integration (OSI), Veterans Engineering Resource Center (VERC), Washington, DC
| | - Amanda S Mixon
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
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23
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Goodrich DE, Lowery JC, Burns JA, Richardson CR. The Phased Implementation of a National Telehealth Weight Management Program for Veterans: Mixed-Methods Program Evaluation. JMIR Diabetes 2018; 3:e14. [PMID: 30305265 PMCID: PMC6307696 DOI: 10.2196/diabetes.9867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/16/2018] [Accepted: 07/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background The burden of obesity is high among US veterans, yet many face barriers to engaging in in-person, facility-based treatment programs. To improve access to weight-management services, the Veterans Health Administration (VHA) developed TeleMOVE, a home-based, 82-day curriculum that utilizes in-home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility-based services. Objective The primary aim was to establish preliminary evidence for the program by comparing outcomes for TeleMOVE with standard, facility-based MOVE weight-management services (group, individual modalities) over the evaluation period based on the number of patients enrolled per site and the program’s clinical effectiveness, as demonstrated by average weight lost per patient. The secondary aim was to understand factors influencing TeleMOVE implementation variability across demonstration sites to develop recommendations to improve national program dissemination. Methods We employed a formative mixed-methods design to evaluate the phased implementation of TeleMOVE at 9 demonstration sites and compare patient- and site-level measures of program uptake. Data were collected between October 1, 2009 and September 30, 2011. Patient-level program outcomes were extracted from VHA patient care databases to evaluate program enrollment rates and clinical outcomes. To assess preliminary clinical effectiveness, weight loss outcomes for veterans who enrolled in TeleMOVE were compared with outcomes for veterans enrolled in standard MOVE! at each demonstration site, as well as with national averages during the first 2 years of program implementation. For the secondary aim, we invited program stakeholders to participate in 2 rounds of semistructured interviews about aspects of TeleMOVE implementation processes, site-level contextual factors, and program delivery. Twenty-eight stakeholders participated in audio-recorded interviews. Results Although stakeholders at 3 sites declined to be interviewed, objective program uptake was high at 2 sites, delayed-high at 2 sites, and low at 5 sites. At 6 months post enrollment, the mean weight loss was comparable for TeleMOVE (n=417) and MOVE! (n=1543) participants at −5.2 lb (SD 14.4) and −5.1 lb (SD 12.2), respectively (P=.91). All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE! due to logistical and technical assistance issues related to the devices. High-uptake sites overcame implementation challenges by leveraging communication networks with stakeholders, adapting the program to patient needs whenever possible, setting programmatic goals and monitoring feedback of results, and taking time to reflect and evaluate on delivery to foster incremental delivery improvements, whereas low-uptake sites reported less leadership support and effective communication among stakeholders. Conclusions This implementation evaluation of a clinical telehealth program demonstrated the value of partnership-based research in which researchers not only provided operational leaders with feedback regarding the effectiveness of a new program but also relevant feedback into contextual factors related to program implementation to enable adaptations for national deployment efforts.
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Affiliation(s)
- David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Julie C Lowery
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Jennifer A Burns
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
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Abstract
This research brief describes the use of acupuncture as a mechanism for the development of crossagency knowledge translation and evidence-based practices in order to ensure the best possible care for the nation's veterans.
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Affiliation(s)
- Cathaleen Madsen
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Tracey Koehlmoos
- Uniformed Services University of the Health Sciences, Bethesda, MD
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25
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Arya S, Khakharia A, Binney ZO, DeMartino RR, Brewster LP, Goodney PP, Wilson PWF. Association of Statin Dose With Amputation and Survival in Patients With Peripheral Artery Disease. Circulation 2018; 137:1435-1446. [PMID: 29330214 PMCID: PMC5882502 DOI: 10.1161/circulationaha.117.032361] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/20/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Statin dose guidelines for patients with peripheral artery disease (PAD) are largely based on coronary artery disease and stroke data. The aim of this study is to determine the effect of statin intensity on PAD outcomes of amputation and mortality. METHODS Using an observational cohort study design and a validated algorithm, we identified patients with incident PAD (2003-2014) in the national Veterans Affairs data. Highest statin intensity exposure (high-intensity versus low-to-moderate-intensity versus antiplatelet therapy but no statin use) was determined within 1 year of diagnosis of PAD. Outcomes of interest were lower extremity amputations and death. The association of statin intensity with incident amputation and mortality was assessed with Kaplan-Meier plots, Cox proportional hazards modeling, propensity score-matched analysis, and sensitivity and subgroup analyses, as well, to reduce confounding. RESULTS In 155 647 patients with incident PAD, more than a quarter (28%) were not on statins. Use of high-intensity statins was lowest in patients with PAD only (6.4%) in comparison with comorbid coronary/carotid disease (18.4%). Incident amputation and mortality risk declined significantly with any statin use in comparison with the antiplatelet therapy-only group. In adjusted Cox models, the high-intensity statin users were associated with lower amputation risk and mortality in comparison with antiplatelet therapy-only users (hazard ratio, 0.67; 95% confidence interval, 0.61-0.74 and hazard ratio, 0.74; 95% confidence interval, 0.70-0.77, respectively). Low-to-moderate-intensity statins also had significant reductions in the risk of amputation and mortality (hazard ratio amputation, 0.81; 95% confidence interval, 0.75- 0.86; hazard ratio death, 0.83; 95% confidence interval, 0.81-0.86) in comparison with no statins (antiplatelet therapy only), but effect size was significantly weaker than the high-intensity statins (P<0.001). The association of high-intensity statins with lower amputation and death risk remained significant and robust in propensity score-matched, sensitivity, and subgroup analyses. CONCLUSIONS Statins, especially high-intensity formulations, are underused in patients with PAD. This is the first population-based study to show that high-intensity statin use at the time of PAD diagnosis is associated with a significant reduction in limb loss and mortality in comparison with low-to-moderate-intensity statin users, and patients treated only with antiplatelet medications but not with statins, as well.
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Affiliation(s)
- Shipra Arya
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery (S.A., A.K., L.P.B.)
- Emory School of Medicine, and Department of Epidemiology, Rollins School of Public Health (S.A., Z.O.B.), Emory University, Atlanta, GA
- Surgical Service Line (S.A., L.P.B.)
| | - Anjali Khakharia
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery (S.A., A.K., L.P.B.)
| | - Zachary O Binney
- Emory School of Medicine, and Department of Epidemiology, Rollins School of Public Health (S.A., Z.O.B.), Emory University, Atlanta, GA
| | - Randall R DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN (R.R.D.)
| | - Luke P Brewster
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery (S.A., A.K., L.P.B.)
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (P.P.G.)
| | - Peter W F Wilson
- Division of Cardiology (P.W.F.W.)
- Epidemiology and Genomic Medicine (P.W.F.W.), Atlanta VA Medical Center, Decatur, GA
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26
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Sestito SF, Rodriguez KL, Saba SK, Conley JW, Mitchell MA, Gordon AJ. Homeless veterans' experiences with substance use, recovery, and treatment through photo elicitation. Subst Abus 2017; 38:422-431. [PMID: 28726549 DOI: 10.1080/08897077.2017.1356422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Homeless veterans often have addictions and comorbidities that complicate utilization of longitudinal health care services, such as primary care. An understanding of experiences of veterans enrolled in a Homeless Patient Aligned Care Team (H-PACT) may improve addiction treatment engagement in these settings. The authors aimed to describe H-PACT veterans' experiences with substance use (SU), substance use recovery (SUR), and substance use treatment (SUT). METHODS Homeless veterans were recruited from a veteran primary care medical home clinic between September 2014 and March 2015. Twenty veterans were given digital cameras and prompts for taking photographs about their health and health care and participated in 2 photo elicitation interviews. For this secondary analysis, transcripts from the audio-recorded interviews were analyzed by 2 coders using qualitative content analysis. RESULTS The majority of participants (75%, n = 15) discussed SU, SUR, and/or SUT in regards to their health and health care utilization. SU themes centered on disclosure of addiction or dependency; substances used; repercussions of SU; SU as a coping mechanism; and association of SU with military service. SUR themes included disclosure of length of sobriety; perceived facilitators of SUR in health, beliefs, social, environmental, financial, and creative pursuit domains; and perceived barriers to SUR in beliefs, social, and environmental domains. SUT themes focused on perceived facilitators of SUT in access to Department of Veterans Affairs (VA) and non-VA services and social domains and perceived barriers to SUT in the social domain. CONCLUSIONS Providers seeking to elicit addiction-related clinical history and facilitate SUR and SUT might look to the current findings for guidance. Provider training in motivational interviewing may be warranted, which allows for an exploration of health-related consequences of SU and supports patients' self-efficacy.
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Affiliation(s)
- Samuel F Sestito
- a Division of General Internal Medicine, Department of Medicine , School of Medicine, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.,b Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - Keri L Rodriguez
- a Division of General Internal Medicine, Department of Medicine , School of Medicine, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.,b Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - Shaddy K Saba
- c Interdisciplinary Addiction Program for Education and Research , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - James W Conley
- b Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
| | - Michael A Mitchell
- d Office of Data Analysis, Research, and Evaluation , Allegheny County Department of Human Services , Pittsburgh , Pennsylvania , USA
| | - Adam J Gordon
- a Division of General Internal Medicine, Department of Medicine , School of Medicine, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.,b Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA.,e Mental Illness Research, Education, and Clinical Center , VA Pittsburgh Healthcare System , Pittsburgh , Pennsylvania , USA
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27
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Garvin LA, Simon SR. Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study. J Med Internet Res 2017; 19:e182. [PMID: 28550008 PMCID: PMC5466699 DOI: 10.2196/jmir.4778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 03/01/2017] [Accepted: 03/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems. Objective The aim of this study was to develop and prioritize measures of digital patient engagement based on patients’ use of the US Department of Veterans Affairs (VA)’s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions. Methods We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures. Results All 12 experts completed the study’s three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian’s three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement). Conclusions This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients’ use of VA’s My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans.
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Affiliation(s)
- Lynn A Garvin
- Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, MA, United States
| | - Steven R Simon
- Geriatrics and Extended Care Service, Veterans Affairs Boston Healthcare System, Boston, MA, United States.,The Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA, United States.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States
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28
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Partin MR, Gravely AA, Burgess JF, Haggstrom DA, Lillie SE, Nelson DB, Nugent SM, Shaukat A, Sultan S, Walter LC, Burgess DJ. Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results. Cancer 2017; 123:3502-3512. [PMID: 28493543 DOI: 10.1002/cncr.30765] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening. METHODS In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records. Patient behaviors (refusal, private sector colonoscopy use) were estimated with statistical text mining conducted on clinic notes, and follow-up predictors and adjusted rates were estimated using hierarchical logistic regression. RESULTS Roughly 50% of individuals completed a colonoscopy at a VHA facility within 6 months. Age and comorbidity score were negatively associated with follow-up. Blacks were more likely to receive follow-up than whites. Environmental factors attenuated but did not fully account for these differences. Patient behaviors (refusal, private sector colonoscopy use) and physician behaviors (inappropriate screening) fully accounted for the small reverse race disparity and attenuated variation by age and comorbidity score. Patient behaviors (refusal and private sector colonoscopy use) contributed more to variation in follow-up rates than physician behaviors (inappropriate screening). CONCLUSIONS In the VHA, blacks are more likely to receive colonoscopy follow-up for positive FOBT/FIT results than whites, and follow-up rates markedly decline with advancing age and comorbidity burden. Patient and physician behaviors explain race variation in follow-up rates and contribute to variation by age and comorbidity burden. Cancer 2017;123:3502-12. Published 2017. This article is a US Government work and is in the public domain in the USA.
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Affiliation(s)
- Melissa R Partin
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Amy A Gravely
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - James F Burgess
- Center for Healthcare Organization and Implementation Research, Boston Veterans Affairs Healthcare System, Boston, Massachusetts.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - David A Haggstrom
- Veterans Affairs Health Services Research & Development Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sarah E Lillie
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David B Nelson
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Sean M Nugent
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Aasma Shaukat
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Shahnaz Sultan
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Louise C Walter
- Division of Geriatrics, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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29
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Wisco BE, Marx BP, May CL, Martini B, Krystal JH, Southwick SM, Pietrzak RH. Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study. Depress Anxiety 2017; 34:340-347. [PMID: 28370818 DOI: 10.1002/da.22614] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/31/2017] [Accepted: 02/17/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Combat exposure is associated with increased risk of mental disorders and suicidality. Moral injury, or persistent effects of perpetrating or witnessing acts that violate one's moral code, may contribute to mental health problems following military service. The pervasiveness of potentially morally injurious events (PMIEs) among U.S. combat veterans, and what factors are associated with PMIEs in this population remains unknown. METHODS Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary and nationally representative survey of a population-based sample of U.S. veterans, including 564 combat veterans, collected September-October 2013. Types of PMIEs (transgressions by self, transgressions by others, and betrayal) were assessed using the Moral Injury Events Scale. Psychiatric and functional outcomes were assessed using established measures. RESULTS A total of 10.8% of combat veterans acknowledged transgressions by self, 25.5% endorsed transgressions by others, and 25.5% endorsed betrayal. PMIEs were moderately positively associated with combat severity (β = .23, P < .001) and negatively associated with white race, college education, and higher income (βs = .11-.16, Ps < .05). Transgressions by self were associated with current mental disorders (OR = 1.65, P < .001) and suicidal ideation (OR = 1.67, P < .001); betrayal was associated with postdeployment suicide attempts (OR = 1.99, P < .05), even after conservative adjustment for covariates, including combat severity. CONCLUSIONS A significant minority of U.S combat veterans report PMIEs related to their military service. PMIEs are associated with risk for mental disorders and suicidality, even after adjustment for sociodemographic variables, trauma and combat exposure histories, and past psychiatric disorders.
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Affiliation(s)
- Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC
| | - Brian P Marx
- U.S. Department of Veterans Affairs National Center for PTSD, VA Boston Healthcare System, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Casey L May
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC
| | - Brenda Martini
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - John H Krystal
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - Steven M Southwick
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
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Rivera JC, Amuan ME, Morris RM, Johnson AE, Pugh MJ. Arthritis, comorbidities, and care utilization in veterans of operations enduring and Iraqi Freedom. J Orthop Res 2017; 35:682-687. [PMID: 27256517 DOI: 10.1002/jor.23323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/25/2016] [Indexed: 02/04/2023]
Abstract
Veteran populations are known to have frequencies of arthritis higher than civilian populations. The aim of this study is to define the prevalence of arthritis among a cohort of veterans from ongoing U.S. military operations. A retrospective cohort study using Veterans Administration data sources for service connected disability, comorbidities, clinic utilization, and pharmacy utilization was conducted including veterans who deployed in service to operations in Afghanistan or Iraq, comparing veterans with a diagnosis of arthritis, arthritis plus back pain, and veterans with no pain diagnoses. The frequency of arthritis was 11.8%. Veterans with arthritis and arthritis plus back pain had greater frequencies of diabetes, hyperlipidemia, hypertension, and obesity compare to veterans with no pain diagnosis. Veterans with arthritis plus back pain had the highest pain clinic utilization and prescription use of opioids and anti-inflammatories. Veterans with no pain diagnosis had higher frequencies of diagnosis and clinic utilization for mental health disorders. Arthritis is prevalent among the latest generation of combat veterans and is associated with diabetes, obesity, and cardiovascular comorbidities. The need for arthritis care and associated comorbidities is expected to increase as the Veterans Administration and the civilian health care sector assumes care of these veterans. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:682-687, 2017.
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Affiliation(s)
- Jessica C Rivera
- US Army Institute of Surgical Research and San Antonio Military Medical Center Department of Orthopaedic Surgery, 3698 Chambers Pass, JBSA Fort Sam Houston, Texas, 78234
| | - Megan E Amuan
- Edith Nourse Roge Memorial Veterans Hospital, Bedford, Massachusetts
| | - Ruth M Morris
- South Texas Veterans Health Care System, San Antonio, Texas
| | - Anthony E Johnson
- San Antonio Military Medical Center Department of Orthopaedic Surgery, JBSA Fort Sam Houston, Texas
| | - Mary Jo Pugh
- South Texas Veterans Health Care System, San Antonio, Texas
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Wyte-Lake T, Claver M, Der-Martirosian C, Davis D, Dobalian A. Developing a Home-Based Primary Care Disaster Preparedness Toolkit. Disaster Med Public Health Prep 2017; 11:56-63. [PMID: 27839522 DOI: 10.1017/dmp.2016.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Health agencies working with the homebound play a vital role in bolstering a community's resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs. METHODS We conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate). RESULTS Respondents with fewer years with the HBPC program rated the toolkit as being more helpful (P<0.05). Of those who implemented their program's disaster protocol most frequently, two-thirds strongly agreed that the toolkit was relevant. Conversely, of those who implemented their disaster protocols very infrequently or never, 23% strongly agreed that the topics covered in the toolkit were relevant to their work (P<0.05). CONCLUSION This toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkit's utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patient's personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56-63).
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Stanton MV, Matsuura J, Fairchild JK, Lohnberg JA, Bayley PJ. Mindfulness as a Weight Loss Treatment for Veterans. Front Nutr 2016; 3:30. [PMID: 27574603 PMCID: PMC4983552 DOI: 10.3389/fnut.2016.00030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/29/2016] [Indexed: 01/23/2023] Open
Abstract
Despite substantial evidence for their effectiveness in treating disordered eating and obesity, mindfulness-based treatments have not been broadly implemented among Veterans. A number of reviews have reported mindfulness to be beneficial in promoting healthy eating behaviors and weight loss among non-Veteran samples. We discuss this approach in the context of the Veterans Affairs system, the largest integrated healthcare provider in the U.S. and in the context of Veterans, among whom obesity is at epidemic proportions. In this article, we discuss what is known about treating obesity using a mindfulness approach, mindfulness interventions for Veterans, a new pilot mindfulness-based weight loss program designed for Veterans, and future directions for this type of obesity treatment in Veterans. We conclude that this population may be uniquely poised to benefit from mindfulness-based treatments.
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Affiliation(s)
- Michael V Stanton
- Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Justin Matsuura
- US Army Health Clinic Schofield Barracks Brain Injury Clinic , Schofield Barracks, HI , USA
| | | | | | - Peter J Bayley
- Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Frisbee KL. Variations in the Use of mHealth Tools: The VA Mobile Health Study. JMIR Mhealth Uhealth 2016; 4:e89. [PMID: 27436165 PMCID: PMC4971391 DOI: 10.2196/mhealth.3726] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 07/13/2015] [Accepted: 03/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods Veteran/family caregiver dyads (N=882) enrolled in VA’s Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results Of the 882 dyads, 94.9% (837/882) of caregivers were women and 95.7% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8% (351/882) lived in rural locations. Most (89%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions This mHealth Family Caregiver pilot project effectively establishes the VA’s first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities.
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Affiliation(s)
- Kathleen L Frisbee
- Connected Health, Office of Informatics and Analytics, Veterans Health Administration, Department of Veteran Affairs, Washington, DC, United States.
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Dixon BE, Ofner S, Perkins SM, Myers LJ, Rosenman MB, Zillich AJ, French DD, Weiner M, Haggstrom DA. Which veterans enroll in a VA health information exchange program? J Am Med Inform Assoc 2016; 24:96-105. [PMID: 27274014 DOI: 10.1093/jamia/ocw058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/06/2016] [Accepted: 03/24/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions. MATERIALS AND METHODS Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients' sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records. RESULTS Among 57 072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50-64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment. DISCUSSION AND CONCLUSION Enrollment in HIE is complex, with several factors involved in a patient's decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation.
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Affiliation(s)
- Brian E Dixon
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN .,Richard M. Fairbanks School of Public Health, Indiana University.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN
| | - Susan Ofner
- Department of Biostatistics, School of Medicine, Indiana University
| | - Susan M Perkins
- Richard M. Fairbanks School of Public Health, Indiana University.,Department of Biostatistics, School of Medicine, Indiana University
| | - Laura J Myers
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University
| | - Marc B Rosenman
- Department of Pediatrics, Children's Health Services Research, Indiana University.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
| | - Alan J Zillich
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN
| | - Dustin D French
- Department of Ophthalmology and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Michael Weiner
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
| | - David A Haggstrom
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
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Hartmann CW, Shwartz M, Zhao S, Palmer JA, Berlowitz DR. Longitudinal Pressure Ulcer Rates After Adoption of Culture Change in Veterans Health Administration Nursing Homes. J Am Geriatr Soc 2016; 64:151-5. [PMID: 26782865 DOI: 10.1111/jgs.13879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To examine facility-level pressure ulcer (PrU) development rates and variations in these rates after a system-wide adoption of culture change in Veterans Health Administration (VHA) nursing homes. DESIGN Four-year retrospective longitudinal design. SETTING VHA facilities (N=109) representing 132 nursing homes known as community living centers (CLCs). PARTICIPANTS VHA nursing home residents. MEASUREMENTS PrUs were identified using fiscal year (FY) 2008-11 Minimum Data Set (MDS) data. PrU development was defined as a Stage 2 or larger PrU on an MDS assessment with no PrU on the previous assessment. A risk adjustment model was developed using 105,274 MDS observations to predict the likelihood of PrUs (c-statistic=0.72). A Bayesian hierarchical model that adjusted for differences in the precision of PrU rates from different-size facilities was used to calculate smoothed risk-adjusted (SRA) rates for each facility. The statistical significance of the trend over the 4 years was determined by examining the 95% interval estimate for the slope. RESULTS Over the 4-year period, the beginning of which coincided with the VHA's system-wide adoption of culture change as a performance measure, median SRA facility PrU development rates were fairly consistent at approximately 4%. The range in SRA rates declined over the years, from a 14.8-percentage point spread to 10.1-percentage point spread. Some facilities had significantly improving SRA rates (e.g., declined steadily from 5.5% to 3.9%) and some had significantly worsening SRA rates (e.g., increased steadily from 5.1% to 7.9%). Seven sites had significantly improving rates (P<.001) that were below the median across all 4 years. CONCLUSION A system-wide culture change implementation did not affect CLC PrU development rates, but there was significant variation in facility rates, and some facilities had sustained high performance.
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Affiliation(s)
- Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts.,Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts
| | - Michael Shwartz
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,School of Management, Boston University, Boston, Massachusetts
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts
| | - Dan R Berlowitz
- Center for Healthcare Organization and Implementation Research, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts.,Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts
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Groër MW, Kostas-Polston EA, Dillahunt-Aspillaga C, Beckie TM, Johnson-Mallard V, Duffy A, Evans ME. Allostatic Perspectives in Women Veterans With a History of Childhood Sexual Assault. Biol Res Nurs 2016; 18:454-64. [PMID: 27067613 DOI: 10.1177/1099800416638442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Women veterans have increased reports of sexual victimization compared to women in general, including childhood sexual assault (CSA) before military service, increasing the risk of military sexual trauma. Findings from recent studies reveal negative health effects following a history of CSA. There is a strong relationship between CSA and revictimization in civilian and military life, which may contribute to allostatic load. OBJECTIVES (1) To determine the relationship between women veterans' CSA history and later sexual assault history and (2) to determine the relationships between women veterans' CSA and primary mediators and secondary and tertiary outcomes of allostasis. RESEARCH DESIGN Cross-sectional. SUBJECTS Women (N = 81), 18-70 years old, veterans of the U.S. Armed Services. MEASURES Participants completed questionnaires and blood and hair samples were collected. Several scales were utilized: Posttraumatic Checklist-Military, Center for Epidemiological Studies-Depression Scale, Pain Outcomes Questionnaire-Short Form, Cohen's Perceived Stress Scale (PSS), Profile of Mood States, and an investigator-developed sexual harassment/assault instrument. RESULTS Thirty-three percent of participants reported CSA; of these, 38.5% reported military sexual assault and 70.3% sexual assault during civilian life. Those with CSA had higher cholesterol, triglycerides, perceived stress scores, and greater pain and fatigue than those without CSA. Hair cortisol was marginally lower in women with CSA when PSS was controlled, suggesting a dampened hypothalamic-pituitary-adrenal axis. CONCLUSIONS These data suggest that some women veterans with a history of CSA may have increased allostatic load and be at increased risk for a variety of later life illnesses.
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Affiliation(s)
| | - Elizabeth A Kostas-Polston
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | | | | | - Allyson Duffy
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Mary E Evans
- College of Nursing, University of South Florida, Tampa, FL, USA
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Wadia RJ, Yao X, Deng Y, Li J, Maron S, Connery D, Gunduz-Bruce H, Rose MG. The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center. Cancer Med 2015; 4:1365-73. [PMID: 26063243 PMCID: PMC4567021 DOI: 10.1002/cam4.483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 12/03/2022] Open
Abstract
There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care.
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Affiliation(s)
- Roxanne J Wadia
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
| | - Xiaopan Yao
- Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Yanhong Deng
- Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Jia Li
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
| | | | - Donna Connery
- Veterans Affairs Healthcare System, West Haven, Connecticut
| | - Handan Gunduz-Bruce
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
| | - Michal G Rose
- Yale School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Healthcare System, West Haven, Connecticut
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Finlay AK, Binswanger IA, Smelson D, Sawh L, McGuire J, Rosenthal J, Blue-Howells J, Timko C, Blodgett JC, Harris AHS, Asch SM, Frayne S. Sex differences in mental health and substance use disorders and treatment entry among justice-involved Veterans in the Veterans Health Administration. Med Care 2015; 53:S105-11. [PMID: 25767963 PMCID: PMC5764085 DOI: 10.1097/mlr.0000000000000271] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over half of veterans in the criminal justice system have mental health or substance use disorders. However, there is a critical lack of information about female veterans in the criminal justice system and how diagnosis prevalence and treatment entry differ by sex. OBJECTIVES To document prevalence of mental health and substance use disorder diagnoses and treatment entry rates among female veterans compared with male veterans in the justice system. RESEARCH DESIGN Retrospective cohort study using national Veterans Health Administration clinical/administrative data from veterans seen by Veterans Justice Outreach Specialists in fiscal years 2010-2012. SUBJECTS A total of 1535 females and 30,478 male veterans were included. MEASURES Demographic characteristics (eg, sex, age, residence, homeless status), mental health disorders (eg, depression, post-traumatic stress disorder), substance use disorders (eg, alcohol and opioid use disorders), and treatment entry (eg, outpatient, residential, pharmacotherapy). RESULTS Among female veterans, prevalence of mental health and substance use disorders was 88% and 58%, respectively, compared with 76% and 72% among male veterans. Women had higher odds of being diagnosed with a mental health disorder [adjusted odds ratio (AOR)=1.98; 95% confidence interval (CI), 1.68-2.34] and lower odds of being diagnosed with a substance use disorder (AOR=0.50; 95% CI, 0.45-0.56) compared with men. Women had lower odds of entering mental health residential treatment (AOR=0.69; 95% CI, 0.57-0.83). CONCLUSIONS Female veterans involved in the justice system have a high burden of mental health disorders (88%) and more than half have substance use disorders (58%). Entry to mental health residential treatment for women is an important quality improvement target.
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Affiliation(s)
- Andrea K. Finlay
- Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA
| | - Ingrid A. Binswanger
- Division of General Internal Medicine University of Colorado School of Medicine, Community Health Services, Denver Health Medical Center, Denver, CO
| | - David Smelson
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Leon Sawh
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
- School of Criminology and Justice Studies, University of Massachusetts, Lowell, Bedford, MA
| | - Jim McGuire
- Department of Veterans Affairs, Veterans Justice Programs
| | - Joel Rosenthal
- Department of Veterans Affairs, Veterans Justice Programs
| | | | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
- Department of Psychiatry and Behavioral Sciences
| | - Janet C. Blodgett
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
| | - Alex H. S. Harris
- Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA
| | - Steven M. Asch
- Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA
| | - Susan Frayne
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
- Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA
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Dixon BE, Haggstrom DA, Weiner M. Implications for informatics given expanding access to care for Veterans and other populations. J Am Med Inform Assoc 2015; 22:917-20. [PMID: 25833394 DOI: 10.1093/jamia/ocv019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 02/23/2015] [Indexed: 11/14/2022] Open
Abstract
Recent investigations into appointment scheduling within facilities operated by the US Department of Veterans Affairs (VA) illuminate systemic challenges in meeting its goal of providing timely access to care for all Veterans. In the wake of these investigations, new policies have been enacted to expand access to care at VA facilities as well as non-VA facilities if the VA is unable to provide access within a reasonable timeframe or a Veteran lives more than 40 miles from a VA medical facility. These policies are similar to broader health reform efforts that seek to expand access to care for other vulnerable populations. In this perspective, we discuss the informatics implications of expanded access within the VA and its wider applicability across the US health system. Health systems will require robust health information exchange, to maintain coordination while access to care is expanded. Existing informatics research can guide short-term implementation; furthermore, new research is needed to generate evidence about how best to achieve the long-term aim of expanded access to care.
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Affiliation(s)
- Brian E Dixon
- 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 Richard M. Fairbanks School of Public Health Indiana University Center for Biomedical Informatics, Regenstrief Institute
| | - David A Haggstrom
- 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 School of Medicine, Indiana University Center for Health Services Research, Regenstrief Institute
| | - Michael Weiner
- 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 School of Medicine, Indiana University Center for Health Services Research, Regenstrief Institute
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Blosnich JR, Kopacz MS, McCarten J, Bossarte RM. Mental Health and Self-directed Violence Among Student Service Members/Veterans in Postsecondary Education. J Am Coll Health 2015; 63:418-426. [PMID: 24918517 PMCID: PMC4263812 DOI: 10.1080/07448481.2014.931282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Using a sample of student service members/veterans, the current study aimed to examine the prevalence of psychiatric diagnoses and suicide-related outcomes and the association of hazardous duty with mental health. PARTICIPANTS Data are from the Fall 2011 National College Health Assessment (N = 27,774). METHODS Logistic regression was used to examine (1) the association of student service member/veteran status with mental health outcomes and (2) the association of hazardous duty with mental health outcomes among student service members/veterans (n = 706). RESULTS Student service members/veterans had higher odds of self-harm than students without military experience. Among student service members/veterans, hazardous duty was positively associated (odds ratio [OR] = 2.00, 95% confidence interval [CI] [1.30, 3.07]) with having a psychiatric diagnosis but negatively associated (OR = 0.41, 95% CI [0.20, 0.85]) with suicidal ideation. CONCLUSIONS Self-harm may be a unique phenomenon among service members/veterans. Suicide prevention with this population should include information about self-harm, and future research should explore whether suicidal intent underlies self-harm.
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Affiliation(s)
- John R. Blosnich
- University of Rochester, Department of Psychiatry
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
| | - Marek S. Kopacz
- U.S. Department of Veterans Affairs, VISN-2 Center of Excellence for Suicide Prevention
| | - Janet McCarten
- U.S. Department of Veterans Affairs, VISN-2 Center of Excellence for Suicide Prevention
| | - Robert M. Bossarte
- University of Rochester, Department of Psychiatry
- U.S. Department of Veterans Affairs, VISN-2 Center of Excellence for Suicide Prevention
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Bradley CS, Nygaard IE, Torner JC, Hillis SL, Johnson S, Sadler AG. Overactive bladder and mental health symptoms in recently deployed female veterans. J Urol 2014; 191:1327-32. [PMID: 24316095 DOI: 10.1016/j.juro.2013.11.100] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE We estimate the prevalence of current overactive bladder symptoms in recently deployed female veterans, and determine if overactive bladder symptoms are associated with problems commonly reported after deployment including mental health symptoms and prior sexual assault. MATERIALS AND METHODS Baseline data were analyzed from a nationwide cohort study of urogenital symptoms in female veterans. Women returning from deployment to Iraq or Afghanistan in the prior 2 years and ending military service were eligible. Self-reported data were collected by computer assisted telephone interview. Overactive bladder and mental health conditions were identified using standardized definitions as well as validated urinary and mental health instruments. Associations between overactive bladder and depression, post-traumatic stress disorder, anxiety and sexual assault were assessed in separate logistic regression models using propensity scores to adjust for confounding. RESULTS The 1,702 participants had a mean (SD) age of 31.1 (8.4) years and were racially/ethnically diverse. Overall 375 participants (22%; 95% CI 20.1, 24.1) reported overactive bladder. Mental health outcomes included post-traumatic stress disorder (19%), anxiety (21%), depression (10%) and prior sexual assault (27%). All outcomes were associated with overactive bladder (adjusted OR 2.7, 95% CI [2.0, 3.6], 2.7 [2.0, 3.5], 2.5 [1.5, 4.3] and 1.4 [1.1, 1.9], respectively). CONCLUSIONS Overactive bladder symptoms occurred in 22% of recently deployed female veterans, and were associated with self-reported mental health symptoms and traumatic events including prior sexual assault. Screening and evaluation for bothersome urinary symptoms and mental health problems appear warranted in female veterans presenting for primary and urological care after deployment.
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Zullig LL, Jackson GL, Provenzale D, Griffin JM, Phelan S, Nieuwsma JA, van Ryn M. Utilization of hospital-based chaplain services among newly diagnosed male Veterans Affairs colorectal cancer patients. J Relig Health 2014; 53:498-510. [PMID: 23054482 PMCID: PMC3578120 DOI: 10.1007/s10943-012-9653-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of the study was to examine utilization of chaplain services among Veterans Affairs patients with colorectal cancer (CRC). In 2009, the Cancer Care Assessment and Responsive Evaluation Studies questionnaire was mailed to VA CRC patients diagnosed in 2008 (67 % response rate). Multivariable logistic regression examined factors associated with chaplain utilization. Of 918 male respondents, 36 % reported utilizing chaplains. Chaplain services were more likely to be utilized by patients with higher pain levels (OR = 1.017; 95 % CI = 0.999-1.035), younger age (age OR = 0.979; 95 % CI = 0.964-0.996), and later cancer stage (early stage OR = 0.743; 95 % CI = 0.559-0.985). Chaplain services are most utilized by younger, sicker patients.
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Affiliation(s)
- Leah L Zullig
- Health Services Research and Development (152), Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC, 27705, USA,
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Thomas CP, Garnick DW, Horgan CM, Miller K, Harris AHS, Rosen MM. Establishing the feasibility of measuring performance in use of addiction pharmacotherapy. J Subst Abuse Treat 2013; 45:11-8. [PMID: 23490233 PMCID: PMC3954716 DOI: 10.1016/j.jsat.2013.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 11/17/2012] [Accepted: 01/22/2013] [Indexed: 11/19/2022]
Abstract
This paper presents the rationale and feasibility of standardized performance measures for use of pharmacotherapy in the treatment of substance use disorders (SUD), an evidence-based practice and critical component of treatment that is often underused. These measures have been developed and specified by the Washington Circle, to measure treatment of alcohol and opioid dependence with FDA-approved prescription medications for use in office-based general health and addiction specialty care. Measures were pilot tested in private health plans, the Veterans Health Administration (VHA), and Medicaid. Testing revealed that use of standardized measures using administrative data for overall use and initiation of SUD pharmacotherapy is feasible and practical. Prevalence of diagnoses and use of pharmacotherapy vary widely across health systems. Pharmacotherapy is generally used in a limited portion of those for whom it might be indicated. An important methodological point is that results are sensitive to specifications, so that standardization is critical to measuring performance across systems.
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Affiliation(s)
- Cindy Parks Thomas
- Schneider Institutes for Health Policy, Brandeis University, Waltham, MA 02454, USA.
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True G, Butler AE, Lamparska BG, Lempa ML, Shea JA, Asch DA, Werner RM. Open access in the patient-centered medical home: lessons from the Veterans Health Administration. J Gen Intern Med 2013; 28:539-45. [PMID: 23192447 DOI: 10.1007/s11606-012-2279-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The Veterans Health Administration (VHA) has undertaken a 5-year initiative to transform to a patient-centered medical home model. An early focus of implementation was on creating open access, defined as continuity and capacity in primary care. OBJECTIVE We describe the impact of readiness for implementation on efforts of pilot teams to make changes to improve access and identify successful strategies used by early adopters to overcome barriers to change. DESIGN A qualitative, formative evaluation of the first 18 months of implementation in one Veterans Integrated Service Network (VISN) spread across six states. PARTICIPANTS Members of local implementation teams including administrators, primary care providers, and staff from primary care clinics located at 10 medical centers and 45 outpatient clinics. APPROACH We conducted site visits during the first 6 months of implementation, observations at Learning Collaboratives, semi-structured interviews, and review of internal organizational documents. All data collection took place between April 2010 and December 2011. KEY RESULTS Early adopters employed various strategies to enhance access, with a focus on decreasing demand for face-to-face care, increasing supply of different types of primary care encounters, and improving clinic efficiencies. Our interviews with key contacts revealed three important areas where readiness for implementation (or lack thereof) had an impact on interventions to improve access: leadership engagement, staffing resources, and access to information and knowledge. CONCLUSIONS Key factors related to readiness for implementation had an impact on which interventions pilot teams could put into place, as well as the viability and sustainability of access gains. Wide variations in interventions to improve access occurring across sites situated within one organization have important implications for efforts to measure the impact of enhanced access on patient outcomes, costs, and other systems-level indicators of the Medical Home.
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Thompson J, Hopman W, Sweet J, VanTil L, MacLean MB, VanDenKerkhof E, Sudom K, Poirier A, Pedlar D. Health-related quality of life of Canadian Forces veterans after transition to civilian life. Can J Public Health 2013; 104:e15-21. [PMID: 23618114 [PMID: 23618114 DOI: 10.1007/bf03405648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Describe health-related quality of life (HRQoL) of former Canadian Forces (CF) men and women in uniform (Veterans) after transition to civilian life, and compare to age- and sex-adjusted Canadian norms. METHODS The 2010 Survey on Transition to Civilian Life was a national computer-assisted telephone survey of CF Regular Force personnel who released during 1998-2007. HRQoL was assessed using the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores. Descriptive analysis of HRQoL was conducted for socio-demographic, health, disability and determinants of health characteristics. RESULTS Mean age was 46 years (range 20-67). Compared to age- and sex-adjusted Canadian averages, PCS (47.3) was low and MCS was similar (52.0). PCS and MCS were variably below average for middle age groups and lowest for non-commissioned ranks, widowed/divorced/separated, 10-19 years of service, physical and mental health conditions, disability, dissatisfaction with finances, seeking work/not working, low social support and difficulty adjusting to civilian life. Among Veterans Affairs Canada clients, 83% had below-average physical PCS, 49% had below-average MCS, and mean PCS (38.2) was significantly lower than mean MCS (48.3). CONCLUSIONS HRQoL varied across a range of biopsychosocial factors, suggesting possible protective factors and vulnerable subgroups that may benefit from targeted interventions. These findings will be of interest to agencies supporting Veterans in transition to civilian life and to researchers developing hypotheses to better understand well-being in Canadian Veterans.
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Abstract
The objective of this study was to examine whether U.S. Veterans more frequently indicate suicide acceptability than non-Veterans. The 2010 General Social Survey, which employed a probability-based sample of U.S. adults, was analyzed by self-reported Veteran status on suicide acceptability in four, separate hypothetical situations regarding ending one's life (i.e., incurable illness, bankruptcy, bringing dishonor/shame upon family, tired of living and ready to die). Veterans were no more likely to endorse suicide as acceptable than their non-Veteran counterparts. Results suggest that attitudes approving of suicide are not different among Veterans in general and non-Veterans. However, future research may need to examine whether subpopulations of Veterans with elevated risk for suicide may report differential attitudes about suicide.
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Affiliation(s)
- John Blosnich
- Department of Veterans Affairs VISN-2 Center of Excellence for Suicide Prevention , University of Rochester, Rochester, New York 14642, USA.
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Allicock M, Ko L, van der Sterren E, Valle CG, Campbell MK, Carr C. Pilot weight control intervention among US veterans to promote diets high in fruits and vegetables. Prev Med 2010; 51:279-81. [PMID: 20600260 DOI: 10.1016/j.ypmed.2010.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/19/2010] [Accepted: 06/12/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obesity is a significant problem among US veterans. Diets high in fruits and vegetables (FV) can lower obesity risk. Health communication interventions are promising strategies for promoting healthy eating. We evaluated whether an enhanced intervention with tailored newsletters and motivational interviewing calls would be more effective than the Veterans Affairs (VA) weight management program, MOVE!, at increasing FV intake among overweight/obese veterans. METHODS Using a quasi-experimental design, 195 veterans at two clinics participated at baseline and 6-month follow-up from 2005 to 2006. Measures included daily FV intake and information processing of the intervention. The control group (MOVE!) received educational information, group sessions, and standard phone calls about weight. The intervention included MOVE! components plus tailored newsletters and motivational interviewing calls. RESULTS The intervention group reported a statistically significant increase in FV servings compared to control (1.7 vs. 1.2; p ≤ 0.05). Veterans who read more of the tailored newsletters (β=0.15, p=0.01) and perceived the messages as important (β=0.12, p<0.01) and applicable to their lives (β=0.12, p<0.01) ate more FV than those who did not. However, receiving MI calls and information processing regarding the calls were not associated with FV intake. CONCLUSION A tailored intervention can impact short term FV intake for obesity prevention.
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