Care For Women Veterans Research Articles

Congressional Expansion of Enhancing Breast Cancer Screening and Care at the Veterans Health Administration.

Despite high screening rates, breast cancer disparities persist among women veterans because of occupational risks and barriers to access. Three essential bills recently passed in Congress seek to expand access to breast cancer screenings and cancer care within the Veterans Health Administration. The Making Advances in Mammography and Medical Options for Veterans Act expands screening via partnerships with the National Cancer Institute, integrating telescreening and upgrading imaging technology. The Dr. Kate Hendricks Thomas Supporting Expanded Review for Veterans In Combat Environments Act broadens eligibility for those exposed to toxins and personalized risk assessments. The bipartisan Sergeant First Class Health Robinson Honoring our Promise to Address Comprehensive Toxics Act extends benefits for toxin-exposed veterans with presumptive conditions, including breast cancer. Further programs such as National TeleOncology, the Breast & Gynecologic Oncology System of Excellence, and research collaborations between the Veterans Health Administration, National Cancer Institute, and Surveillance, Epidemiology and End Results Program seek to improve access, enhance understanding and care for women veterans with cancer, and mark significant progress in comprehensive care.

Veterans Health Administration Screening for Military Sexual Trauma May Not Capture Over Half of Cases Among Midlife Women Veterans.

Approximately 1 in 3 women veterans endorse military sexual trauma (MST) during Veterans Health Administration (VHA) screening. Higher rates have been reported in anonymous surveys. We compared MST identified by VHA screening to survey-reported MST within the same sample and identified participant characteristics associated with discordant responses. Cross-sectional data were drawn from an observational study of women veterans aged 45-64 enrolled in VHA care in Northern California, with data from mail- and web-based surveys linked to VHA electronic health records (EHRs). Between March 2019 and May 2020, participants reported sociodemographic characteristics, current depressive (Patient Health Questionnaire-9) and posttraumatic stress (PTSD checklist for DSM-5) symptoms, and MST (using standard VHA screening questions) in a survey; depression and posttraumatic stress disorder diagnoses (ICD-10 codes) and documented MST were identified from EHRs. Associations between sociodemographic characteristics, mental health symptoms and diagnoses, and discordant MST reports (EHR-documented MST vs. MST reported on survey, not in EHR) were examined with multivariable logistic regression. In this sample of midlife women veterans (n=202; mean age 56, SD=5), 40% had EHR-documented MST, and 74% reported MST on the survey. Sociodemographic characteristics, mental health symptoms, and diagnosed depression were not associated with discordant MST responses. Women with an EHR-documented PTSD diagnosis had fivefold higher odds of having EHR-documented MST (vs. survey only; odds ratio 5.2; 95% confidence interval 2.3-11.9). VHA screening may not capture more than half of women who reported MST on the survey. VHA screening may underestimate true rates of MST, which could lead to a gap in recognition and care for women veterans.

Computerized Intervention in Primary Care for Women Veterans with Sexual Assault Histories and Psychosocial Health Risks: a Randomized Clinical Trial

ImportanceSexual assault is a public health concern for women and is associated with subsequent psychosocial health risks of posttraumatic stress disorder (PTSD), hazardous drinking, and intimate partner violence (IPV). Sexual assault is associated with social stigma and other barriers shown to inhibit one from seeking mental health care. Digital health technologies may overcome these barriers.ObjectiveTo test the impact of a brief computerized intervention delivered in primary care to reduce health risks and increase mental health treatment utilization among women with histories of sexual assault and current health risks.Design, Setting, and ParticipantsThe Safe and Healthy Experiences (SHE) program was tested in a randomized controlled trial with N = 153 women veterans at a Veterans Health Administration (VHA) medical center, and they completed assessments at baseline, 2 months, and 4 months.InterventionSHE is a brief motivational interviewing and psychoeducation-based computerized intervention. SHE was compared to a screen and referral-only control condition.Main MeasuresHealth risks were measured via validated self-report instruments. Treatment initiation and utilization were measured via self-report and chart review.ResultsSHE did not impact women’s number of health risks (all p’s > .05). However, women randomized to SHE showed significantly greater increases in treatment use compared to women in the control group, as measured by chart review (χ2 (1, n = 153) = 4.38, p = .036, rs = .16), and self-report (χ2 (1, n = 130) = 5.89, p = .015, rs = .21). SHE was found to be an acceptable intervention.ConclusionsSHE was effective in improving mental health treatment initiation and utilization compared to a control group. Computer-based interventions to address sexual trauma and its consequences are acceptable, are highly scalable, and can add value to primary care with little cost or increase in provider time.Trial RegistrationClinicaltrials.gov identifier NCT02957747.

(317) Development of a Semi-Structured Interview to Understand VA Treatment Barriers for Clinicians Treating Women Veterans with Fibromyalgia: A Qualitative Pilot Study

Fibromyalgia (FM) is a vexing pain condition that primarily impacts women with a history of trauma. Women veterans experience posttraumatic stress disorder in their lifetime almost twice as often as their civilian counterparts (13.4% vs. 8.0%). Due to their high rates of trauma exposure, women veterans are at an increased risk of developing FM, with rates higher than those in the civilian population (5.1% vs. 2.0%). The present pilot study seeks to identify preferences for care for women veterans with FM at the Boston VA Healthcare System (VABHS) through qualitative interviews with patients and health care providers. Data from patient interviews (n = 13) has identified several themes including a desire for improved multidisciplinary care and provider education on FM. Using this information, we developed a semi-structured interview script for providers who are most likely to serve as a primary care physician for FM patients including neurologists, rheumatologists, pain specialists, and women's health clinicians. The script also includes open-ended questions about provider knowledge of FM, preferred treatment options, utilization of multidisciplinary teams/resources, and successes and difficulties in providing optimal care to FM patients. Provider and patient interview data are expected to reveal details about the VABHS's efficacy in providing adequate care to an expanding population of women veterans. We hope to use this information to create educational materials on FM and methods to improve communication between providers. This project was funded by the Veterans Affairs Central Office. (Wolfe, Arthritis Rheumatol, 1995; Al-Allaf, Rheumatology, 2002; Lehavot, Am J Prev Med, 2018; Mohanty, Med Care, 2015)

Coordinating Care for Reproductive Health Malignancies in the Veterans' Health Administration: Promising Practices, Ongoing Challenges, and Future Research.

In cancer care, communication and coordination across the cancer continuum is paramount for delivering effective, high-quality, patient-centered care. However, achieving optimally coordinated cancer care is inherently challenging, especially in the case of Veterans Administration (VA) care for women's reproductive health cancers. Given the relatively small number of women Veterans requiring care for reproductive malignancies, VA often must rely on community providers to deliver this care, necessitating coordination across two or more health care systems. Recently, VA has invested heavily in improving care for women Veterans through several initiatives and efforts. This article reviews VA's successes, challenges, and future opportunities in research and innovation in the context of care coordination across the cancer continuum (i.e., prevention and screening, diagnosis and treatment, survivorship care, palliative and supportive care) for women Veterans with reproductive health malignancies. We describe how coordination of VA care for reproductive health malignancies currently reflects a mix of successes that demonstrate use of strong evidenced-based practices and challenges, with solutions yet to be fully developed and implemented. We conclude that there are a multitude of opportunities for future research, interventions, and potential avenues for implementing innovative approaches to coordinate VA reproductive cancer care across the cancer continuum.

Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research

BackgroundThe Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women’s Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women’s Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans’ engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health.Methods/DesignThe three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women’s health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans’ mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design.DiscussionEMPOWER represents a coherent program of women’s health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans’ engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women’s Health, to disseminate and spread the programs nationally.Trial registrationThe two implementation research studies described in this protocol have been registered as required:Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534, registered 9 December 2016.Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961, registered 21 October 2016.

Attitudes, Practices, and Experiences with Implementing a Patient-Centered Medical Home for Women Veterans

BackgroundDespite the growing demand for health care among women veterans in the Veterans Health Administration (VHA), little is known about the perspectives of primary care providers (PCPs) and other primary care staff about the care they provide to women veterans. We sought to understand whether barriers to, attitudes about, and practices in caring for women veterans were associated with two measures of implementation of the VHA patient-centered medical home for women veterans (self-efficacy and satisfaction). MethodsWe administered a cross-sectional survey by Internet from September 8, 2014, through April 27, 2015 (and by mail from December 16, 2014, through June 18, 2015) to all PCPs and affiliated primary care staff in 12 VHA medical centers. We used descriptive and bivariate analyses to characterize their barriers, attitudes, and practices regarding care for women veterans; and ordinary least squares regression to identify associations with satisfaction and self-efficacy regarding medical home implementation for women veterans among members of a VHA patient-centered medical home teamlet for women patients. ResultsOf 775 surveys sent, 288 were completed (94 PCPs and 194 staff) for a response rate of 37% (33% for PCPs; 39% for staff). On average, providers had one female patient for every five patients in their panels. Lower perceived barriers, higher gender-sensitive attitudes, and being a PCP were significantly associated with satisfaction and self-efficacy of patient-centered medical home for women patients. ConclusionsTraining efforts focused on eliminating perceived barriers and strengthening positive attitudes toward women may be more successful than changing women's health practice characteristics alone.

VA Research: Committed to Women Who Have “Borne the Battle” and Beyond

In increasing numbers, women have been serving in the military and playing critical roles in our Nation’s recent wars in Iraq and Afghanistan. The U.S. Department of Veterans Affairs (VA) stands ready to fulfill President Lincoln’s promise “To care for him [and her] who shall have borne the battle” and serve and honor America’s women veterans. The VA has proudly cared for women veterans from all eras, but their recent surge in numbers demands changes in the VA’s health care system. Throughout its history, the VA has demonstrated its ability to innovate to meet evolving needs. Under the leadership of Secretary Eric K. Shinseki, the VA has set forth an ambitious agenda to transform the VA and its health care system, including expanding health care access and improving the culture of VA care for women veterans. Research is one of the keys to the success of this transformation. Improving the health and health care of women veterans has been a research priority within VA since the 1990s. However, in anticipationof thegrowingnumbersofwomenveterans, research to improve their health and health care has assumed heightened urgency. In 2004, the VA Office of Research and Development established the first comprehensive VAwomen’s health research agenda directed toward positioning VA as a national leader in women’s health care (Yano et al., 2006). Subsequently, there has been dramatic growth in research aimed at understanding the needs of women veterans, and their access to and use of care (Bean-Mayberry, et al., 2010; Washington, Yano, Simon, Canning, & Sun, 2006). Importantly, VA research has promoted implementation of new effective treatments (e.g., of posttraumatic stress disorder amongwomen veterans; Schnurr et al., 2007) and policy and program changes in the organization and delivery of care (Veterans Health Administration, 2008; Yano,Washington & Bean-Mayberry, 2008; Yano, Rose, et. al., 2010) in a health care system eager to translate research into more effective practice to meet women veterans’ needs and preferences. The value of the VA’s research agenda-setting and planning effort is evident in the growth of the women’s health research

Improving health care for women veterans

Improving health care for women veterans

Improvements in VA health services for women veterans.

Since the early 1980s, health care for women veterans in the Department of Veterans Affairs (VA) has improved considerably, although problems still remain. The lack of privacy for women at many VA facilities and the provision of incomplete physical examinations for women continue to be problematic issues. A 1992 congressional appropriation of $7.5 million has substantially increased the awareness of women veterans health care in the VA. This appropriation, from Public Law 102-585, Veterans Health Care Act of 1992, Title I-Women Veterans Health Programs, has allowed VA to expand services for women veterans. Using these funds, VA has established eight comprehensive women veterans health centers, 23 full-time women veterans coordinators, and four regional stress disorder teams. This paper describes these and other important new initiatives and discusses how they will serve as the foundation on which VA expands care for women within the context of a changing health care system.