Access to Care for Women Veterans: Delayed Healthcare and Unmet Need

Washington, Donna L.; Bean-Mayberry, Bevanne; Riopelle, Deborah; Yano, Elizabeth M.

doi:10.1007/s11606-011-1772-z

Cited by 162 publications

(124 citation statements)

References 17 publications

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“…Axis I mental conditions were categorized from ICD-9 codes according to prior research that used the Agency for Healthcare Research and Quality Clinical Classifications Software framework (20), with diagnoses recorded at two or more past-year encounters (21). Comorbid mental illness was defined as mental diagnoses in two or more categories.…”

Section: Methodsmentioning

confidence: 99%

Patient-Centered Mental Health Care for Female Veterans

Kimerling¹,

Bastian²,

Bean-Mayberry³

et al. 2015

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Objective-Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding women's needs and priorities is essential to guide the implementation of patient-centered behavioral health services.Methods-In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated women's mental health services for each of the mental health services that emerged as key priorities.Portions of this article were presented at the annual research meeting of the Academy Health, Baltimore, June 23-25, 2013.The authors report no financial relationships with commercial interests. U.S. Department of Veterans Affairs VA Author ManuscriptVA Author Manuscript VA Author ManuscriptResults-Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as women's key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated women's mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated women's services.Conclusions-Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women's mental health care in the VHA.Implementation of patient-centered behavioral health services in primary care is improving the quality of mental health care in the Veterans Health Administration (VHA) (1) and may be especially effective in improving the quality of care for underrepresented populations (2-5). For example, a patient-centered approach helps address the unique mental health needs of women in VHA care, who constitute only 6% of all veteran users in a predominantly male system (6,7) but who are one of the most rapidly growing subpopulations of patients within the VHA (8). Historically, women utilizing VHA services have faced gender disparities in access to and quality of primary care, preventive services, and mental health care (9,10), which led to the implementation of comprehensive primary care for female veterans across the system (11,12). Mental health services for women still vary across the VHA, without consensus on the need for, or org...

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Section: Methodsmentioning

confidence: 99%

Patient-Centered Mental Health Care for Female Veterans

Kimerling¹,

Bastian²,

Bean-Mayberry³

et al. 2015

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“…Greater reliance on community providers for women's services increases care coordination demands on PACT teams. Women veterans also tend to bypass community-based practices to get to women's clinics at larger VA medical centers, 32 which may meet their preferences but adversely affect PACT continuity measures.…”

Section: Pact and Women Veterans' Healthmentioning

confidence: 99%

Delivery of Gender-Sensitive Comprehensive Primary Care to Women Veterans: Implications for VA Patient Aligned Care Teams

2014

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The Veterans Health Administration (VA) has undertaken a major initiative to transform primary care delivery through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home concept, PACTs aim to improve access, continuity, coordination, and comprehensiveness using teambased care that is patient driven and patient centered. However, how PACT principles should be applied to meet the needs of special populations, including women veterans, is not entirely clear. While historical differences in military participation meant women veterans were rarely seen in VA healthcare settings, they now represent the fastest growing segment of new VA users. They also have complex healthcare needs, adding gender-specific services and other needs to the spectrum of services that the VA must deliver. These trends are changing the VA landscape, introducing challenges to how VA care is organized, how VA providers need to be trained, and how VA considers implementation of new initiatives, such as PACT. We briefly describe the evolution of VA primary care delivery for women veterans, review VA policy for delivering gender-sensitive comprehensive primary care for women, and discuss the challenges that women veterans' needs pose in the context of PACT implementation. We conclude with recommendations for addressing some of these challenges moving forward.KEY WORDS: primary care; women's health; veterans.

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“…17,18 Predisposing, enabling, and need characteristics of individuals in the general population, as well as those related to veteran status, were included. 14 We identified characteristics as general versus veteran-specific, because clinicians in community settings may be less aware of veteran-specific characteristics of their patients.…”

Section: Methodsmentioning

confidence: 99%

“…Our methods have been described previously. 13,14 In brief, the sampling frame for NSWV was created by cross-linking Veterans Health Administration, Veterans Benefits Administration and Department of Defense databases, that collectively identified more than 50 % of U.S. women veterans. 13 The NSWV enrolled a stratified random sample of women veterans, with stratification based on VA ambulatory care use (VA use/non-use) and military service period.…”

Section: Study Design and Samplementioning

confidence: 99%

PTSD Risk and Mental Health Care Engagement in a Multi-War Era Community Sample of Women Veterans

et al. 2013

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BACKGROUND: Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized. OBJECTIVES: Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample. DESIGN AND PARTICIPANTS: Cross-sectional, population-based 2008-2009 national survey of 3,611 WVs, weighted to the population. MAIN MEASURES: We screened for PTSD using a validated instrument, and also assessed demographic characteristics, health characteristics, and MHC use in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of MHC use. KEY RESULTS: Overall, 13.0 % (95 % confidence interval [CI] 9.8-16.2) of WVs screened PTSD-positive. Veterans Health Administration (VA) healthcare was used by 31.1 % of PTSD-positives and 11.4 % of PTSD-negatives (p<0.001). Among those screening positive, 48.7 % (95 % CI 35.9-61.6) used MHC services (66.3 % of VA-users, 40.8 % of VA-nonusers; p<0.001). Having a diagnosis of depression (OR=8.6; 95 % CI 1.5-48.9) and VA healthcare use (OR=2.7; 95 % CI 1.1-7.0) predicted MHC use, whereas lacking a regular provider for health care (OR=0.2; 95 % CI 0.1-0.4) and household income below the federal poverty level (OR=0.2; 95 % CI 0.1-0.5) predicted nonuse. CONCLUSIONS: More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs' PTSD risk and available evidencebased VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VAusers is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.

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Access to Care for Women Veterans: Delayed Healthcare and Unmet Need

Cited by 162 publications

References 17 publications

Patient-Centered Mental Health Care for Female Veterans

Patient-Centered Mental Health Care for Female Veterans

Delivery of Gender-Sensitive Comprehensive Primary Care to Women Veterans: Implications for VA Patient Aligned Care Teams

PTSD Risk and Mental Health Care Engagement in a Multi-War Era Community Sample of Women Veterans

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