Women Veterans' Healthcare Needs, Utilization, and Preferences in Veterans Affairs Primary Care Settings

Kate L Sheahan, Karen M Goldstein, Claire T Than, Bevanne Bean-Mayberry, Catherine C Chanfreau, Megan R Gerber, Danielle E Rose, Julian Brunner, Ismelda A Canelo, Jill E Darling Mshs, Sally Haskell, Alison B Hamilton, Elizabeth M Yano, Kate L Sheahan, Karen M Goldstein, Claire T Than, Bevanne Bean-Mayberry, Catherine C Chanfreau, Megan R Gerber, Danielle E Rose, Julian Brunner, Ismelda A Canelo, Jill E Darling Mshs, Sally Haskell, Alison B Hamilton, Elizabeth M Yano

Abstract

Background: The Veterans Health Administration (VA) is the largest integrated health system in the US and provides access to comprehensive primary care. Women Veterans are the fastest growing segment of new VA users, yet little is known about the characteristics of those who routinely access VA primary care in general or by age group.

Objective: Describe healthcare needs, utilization, and preferences of women Veterans who routinely use VA primary care.

Participants: 1,391 women Veterans with 3+ primary care visits within the previous year in 12 VA medical centers (including General Primary Care Clinics, General Primary Care Clinics with designated space for women, and Comprehensive Women's Health Centers) in nine states.

Methods: Cross-sectional survey (45% response rate) of sociodemographic characteristics, health status (including chronic disease, mental health, pain, and trauma exposure), utilization, care preferences, and satisfaction. Select utilization data were extracted from administrative data. Analyses were weighted to the population of routine users and adjusted for non-response in total and by age group.

Key results: While 43% had health coverage only through VA, 62% received all primary care in VA. In the prior year, 56% used VA mental healthcare and 78% used VA specialty care. Common physical health issues included hypertension (42%), elevated cholesterol (39%), pain (35%), and diabetes (16%). Many screened positive for PTSD (41%), anxiety (32%), and depression (27%). Chronic physical and mental health burdens varied by age. Two-thirds (62%) had experienced military sexual trauma. Respondents reported satisfaction with VA women's healthcare and preference for female providers.

Conclusions: Women Veterans who routinely utilize VA primary care have significant multimorbid physical and mental health conditions and trauma histories. Meeting women Veterans' needs across the lifespan will require continued investment in woman-centered primary care, including integrated mental healthcare and emphasis on trauma-informed, age-specific care, guided by women's provider preferences.

Trial registration: ClinicalTrials.gov NCT02039856.

Keywords: Veterans; mental health; primary care; trauma; women’s health.

Conflict of interest statement

The authors declare that they do not have a conflict of interest

© 2022. The Author(s).

References

    1. Frayne SM, Phibbs CS, Saechao F, et al. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 4: Longitudinal Trends in Sociodemographics, Utilization, Health Profile, and Geographic Distribution. 2018. Accessed 30 March 2021.
    1. Eibner C, Krull H, Brown KM, et al. Current and projected characteristics and unique health care needs of the patient population served by the Department of Veterans Affairs. Rand Health Q. 2016;5(4):13.
    1. National Center for Veterans Analysis and Statistics. The Veteran Population Projection Model 2018 (VetPop2018). Accessed April 20, 2021.
    1. U.S. General Accounting Office. Actions needed to ensure that female veterans have equal access to VA benefits. 1982.
    1. VHA DIRECTIVE 1330.01: Health Care for Women Veterans (Veterans Health Administration ) (2017).
    1. The United States Senate Committee on Veterans’ Affairs. Tester’s Historic Deborah Sampson Act Signed Into Law. Accessed April 20, 2021.
    1. Washington DL, Bean-Mayberry B, Riopelle D, Yano EM. Access to care for women veterans: delayed healthcare and unmet need. J Gen Intern Med. 2011;26(Suppl 2):655–61. doi: 10.1007/s11606-011-1772-z.
    1. Washington DL, Farmer MM, Mor SS, Canning M, Yano EM. Assessment of the healthcare needs and barriers to VA use experienced by women veterans: findings from the national survey of women Veterans. Med Care. 2015;53(4 Suppl 1):S23–31. doi: 10.1097/MLR.0000000000000312.
    1. Evans EA, Tennenbaum DL, Washington DL, Hamilton AB. Why women veterans do not use VA-provided health and social services: Implications for health care design and delivery. J Humanist Psychol 2019;
    1. Mattocks KM, Yano EM, Brown A, Casares J, Bastian L. Examining Women Veteran’s experiences, perceptions, and challenges with the veterans choice program. Med Care. 2018;56(7):557–560. doi: 10.1097/MLR.0000000000000933.
    1. Marshall V, Stryczek KC, Haverhals L, et al. The focus they deserve: improving Women Veterans’ Health Care Access. Womens Health Issues. 2021;31(4):399–407. doi: 10.1016/j.whi.2020.12.011.
    1. Yano EM, Darling JE, Hamilton AB, et al. Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans. Implement Sci. 2016;11(1):101. doi: 10.1186/s13012-016-0461-z.
    1. Haskell S. 2017 WATCH: An update on the Implementation of Comprehensive Women’s Health. 2018:
    1. Liu Y, Sayam S, Shao X, et al. Prevalence of and trends in diabetes among Veterans, United States, 2005-2014. Prev Chronic Dis. 2017;14:E135. doi: 10.5888/pcd14.170230.
    1. Jakob JM, Lamp K, Rauch SA, Smith ER, Buchholz KR. The impact of trauma type or number of traumatic events on PTSD diagnosis and symptom severity in treatment seeking veterans. J Nerv Ment Dis. 2017;205(2):83–86. doi: 10.1097/NMD.0000000000000581.
    1. Naylor JC, Ryan Wagner H, Brancu M, et al. Self-reported pain in male and female iraq/afghanistan-era veterans: associations with psychiatric symptoms and functioning. Pain Med. 2017;18(9):1658–1667. doi: 10.1093/pm/pnw308.
    1. Runnals JJ, Garovoy N, McCutcheon SJ, et al. Systematic review of women veterans’ mental health. Womens Health Issues. 2014;24(5):485–502. doi: 10.1016/j.whi.2014.06.012.
    1. Hoggatt KJ, Jamison AL, Lehavot K, Cucciare MA, Timko C, Simpson TL. Alcohol and drug misuse, abuse, and dependence in women veterans. Epidemiol Rev. 2015;37:23–37. doi: 10.1093/epirev/mxu010.
    1. Vimalananda VG, Miller DR, Christiansen CL, Wang W, Tremblay P, Fincke BG. Cardiovascular disease risk factors among women veterans at VA medical facilities. J Gen Intern Med. 2013;28(Suppl 2):S517–23. doi: 10.1007/s11606-013-2381-9.
    1. Fan VS, Au D, Heagerty P, Deyo RA, McDonell MB, Fihn SD. Validation of case-mix measures derived from self-reports of diagnoses and health. J Clin Epidemiol. 2002;55(4):371–80. doi: 10.1016/s0895-4356(01)00493-0.
    1. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92. doi: 10.1097/01.MLR.0000093487.78664.3C.
    1. Lang AJ, Wilkins K, Roy-Byrne PP, et al. Abbreviated PTSD Checklist (PCL) as a guide to clinical response. Gen Hosp Psychiatry. 2012;34(4):332–8. doi: 10.1016/j.genhosppsych.2012.02.003.
    1. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25. doi: 10.7326/0003-4819-146-5-200703060-00004.
    1. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):217–27. doi: 10.1002/hec.4730020305.
    1. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95. doi: 10.1001/archinte.158.16.1789.
    1. Kimerling R, Gima K, Smith MW, Street A, Frayne S. The Veterans Health Administration and military sexual trauma. Am J Public Health. 2007;97(12):2160–6. doi: 10.2105/AJPH.2006.092999.
    1. Scholle SH, Weisman CS, Anderson RT, Camacho F. The development and validation of the primary care satisfaction survey for women. Womens Health Issues. 2004;14(2):35–50. doi: 10.1016/j.whi.2004.03.001.
    1. National Center for Health Statistics. Health, United States, 2019; Table 023. 2021. Accessed June 6, 2021.
    1. National Center for Health Statistics. Health, United States, 2019: Figure 012. 2021. Accessed June 6, 2021.
    1. National Center for Health Statistics. Health, United States, 2019; Table 014. 2021. Accessed June 21, 2021.
    1. Lehavot K, Hoerster KD, Nelson KM, Jakupcak M, Simpson TL. Health indicators for military, veteran, and civilian women. Am J Prev Med. 2012;42(5):473–80. doi: 10.1016/j.amepre.2012.01.006.
    1. National Center for Health Statistics. Health, United States, 2019: Table 020. Accessed June 20, 2021,
    1. Johnson CS, Heffner JL, Blom TJ, Anthenelli RM. Exposure to traumatic events among treatment-seeking, alcohol-dependent women and men without PTSD. J Trauma Stress. 2010;23(5):649–52. doi: 10.1002/jts.20563.
    1. Gross GM, Bastian LA, Smith NB, Harpaz-Rotem I, Hoff R. Sex differences in associations between depression and posttraumatic stress disorder symptoms and tobacco use among veterans of recent conflicts. J Womens Health (Larchmt) 2020;29(5):677–685. doi: 10.1089/jwh.2019.8082.
    1. Haskell SG, Brandt CA, Krebs EE, Skanderson M, Kerns RD, Goulet JL. Pain among veterans of operations enduring freedom and iraqi freedom: do women and men differ? Pain Med. 2009;10(7):1167–73. doi: 10.1111/j.1526-4637.2009.00714.x.
    1. Naylor JC, Wagner HR, Johnston C, et al. Pain intensity and pain interference in male and female Iraq/Afghanistan-era veterans. Womens Health Issues. 2019;29(Suppl 1):S24–S31. doi: 10.1016/j.whi.2019.04.015.
    1. Avluk OC, Gurcay E, Gurcay AG, Karaahmet OZ, Tamkan U, Cakci A. Effects of chronic pain on function, depression, and sleep among patients with traumatic spinal cord injury. Ann Saudi Med. 2014;34(3):211–6. doi: 10.5144/0256-4947.2014.211.
    1. Blosnich JR, Montgomery AE, Taylor LD, Dichter ME. Adverse social factors and all-cause mortality among male and female patients receiving care in the Veterans Health Administration. Prev Med. 2020;141:106272. doi: 10.1016/j.ypmed.2020.106272.
    1. Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Bastian LA, Mattocks KM. Rates and correlates of depression symptoms in a sample of pregnant veterans receiving Veterans Health Administration Care. Womens Health Issues. 2019;29(4):333–340. doi: 10.1016/j.whi.2019.04.008.
    1. Lehavot K, Katon JG, Chen JA, Fortney JC, Simpson TL. Post-traumatic stress disorder by gender and veteran status. Am J Prev Med. 2018;54(1):e1–e9. doi: 10.1016/j.amepre.2017.09.008.
    1. MacIntosh HB, Menard AD. Where are we now? A consolidation of the research on long-term impact of child sexual abuse. J Child Sex Abus. 2021;30(3):253–257. doi: 10.1080/10538712.2021.1914261.
    1. Suris A, Lind L. Military sexual trauma: a review of prevalence and associated health consequences in veterans. Trauma Violence Abuse. 2008;9(4):250–69. doi: 10.1177/1524838008324419.
    1. Goldberg SB, Livingston WS, Blais RK, et al. A positive screen for military sexual trauma is associated with greater risk for substance use disorders in women veterans. Psychol Addict Behav. 2019;33(5):477–483. doi: 10.1037/adb0000486.
    1. Kimerling R, Makin-Byrd K, Louzon S, Ignacio RV, McCarthy JF. Military sexual trauma and suicide mortality. Am J Prev Med. 2016;50(6):684–691. doi: 10.1016/j.amepre.2015.10.019.
    1. Brignone E, Gundlapalli AV, Blais RK, et al. Differential risk for homelessness among US Male and Female Veterans with a positive screen for military sexual trauma. JAMA Psychiatry. 2016;73(6):582–9. doi: 10.1001/jamapsychiatry.2016.0101.
    1. Turner AP, Harding KA, Brier MJ, Anderson DR, Williams RM. Military sexual trauma and chronic pain in veterans. Am J Phys Med Rehabil. 2020;99(11):1020–1025. doi: 10.1097/PHM.0000000000001469.
    1. Sumner JA, Lynch KE, Viernes B, et al. Military sexual trauma and adverse mental and physical health and clinical comorbidity in women veterans. Womens Health Issues. 2021;10.1016/j.whi.2021.07.004
    1. Creech SK, Swift R, Zlotnick C, Taft C, Street AE. Combat exposure, mental health, and relationship functioning among women veterans of the Afghanistan and Iraq wars. J Fam Psychol. 2016;30(1):43–51. doi: 10.1037/fam0000145.
    1. Hassija CM, Jakupcak M, Maguen S, Shipherd JC. The influence of combat and interpersonal trauma on PTSD, depression, and alcohol misuse in U.S. Gulf War and OEF/OIF women veterans. J Trauma Stress. 2012;25(2):216–9. doi: 10.1002/jts.21686.
    1. Cobb Scott J, Pietrzak RH, Southwick SM, et al. Military sexual trauma interacts with combat exposure to increase risk for posttraumatic stress symptomatology in female Iraq and Afghanistan veterans. J Clin Psychiatry. 2014;75(6):637–43. doi: 10.4088/JCP.13m08808.
    1. Dichter ME, Cerulli C, Bossarte RM. Intimate partner violence victimization among women veterans and associated heart health risks. Womens Health Issues. 2011;21(4 Suppl):S190–4. doi: 10.1016/j.whi.2011.04.008.
    1. Gerber MR, Iverson KM, Dichter ME, Klap R, Latta RE. Women veterans and intimate partner violence: current state of knowledge and future directions. J Womens Health (Larchmt). 2014;23(4):302–9. doi: 10.1089/jwh.2013.4513.
    1. Gerber MR, Elisseou S, Sager ZS, Keith JA. Trauma-informed telehealth in the COVID-19 era and beyond. Fed Pract. 2020;37(7):302–308.
    1. Leung LB, Rubenstein LV, Post EP, et al. Association of Veterans Affairs Primary Care Mental Health Integration with care access among Men and Women Veterans. JAMA Netw Open. 2020;3(10):e2020955. doi: 10.1001/jamanetworkopen.2020.20955.
    1. Yano EM, Hamilton AB. Accelerating delivery of trauma-sensitive care: using multilevel stakeholder engagement to improve care for women veterans. Fam Syst Health. 2017;35(3):373–375. doi: 10.1037/fsh0000288.
    1. Bergman AA, Hamilton AB, Chrystal JG, Bean-Mayberry BA, Yano EM. Primary care providers’ perspectives on providing care to women veterans with histories of sexual trauma. Womens Health Issues. 2019;29(4):325–332. doi: 10.1016/j.whi.2019.03.001.
    1. Assistant Under Secretary for Clinical Services/Chief Medical Officer. Trauma-Infomed Care (TIC) Approach (VIEWS 5592562). 2021.
    1. Vanitallie TB. Stress: a risk factor for serious illness. Metabolism. 2002;51(6 Suppl 1):40–5. doi: 10.1053/meta.2002.33191.
    1. Weiss T, Skelton K, Phifer J, et al. Posttraumatic stress disorder is a risk factor for metabolic syndrome in an impoverished urban population. Gen Hosp Psychiatry. 2011;33(2):135–42. doi: 10.1016/j.genhosppsych.2011.01.002.
    1. Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29(2):147–55. doi: 10.1016/j.genhosppsych.2006.11.005.
    1. Ebrahimi R, Lynch KE, Beckham JC, et al. Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans. JAMA Cardiol. 2021;6(6):642–651. doi: 10.1001/jamacardio.2021.0227.
    1. Bastian LA, Trentalange M, Murphy TE, et al. Association between women veterans’ experiences with VA outpatient health care and designation as a women’s health provider in primary care clinics. Womens Health Issues. 2014;24(6):605–12. doi: 10.1016/j.whi.2014.07.005.
    1. Bean-Mayberry B, Bastian L, Trentalange M, et al. Associations between provider designation and female-specific cancer screening in women Veterans. Med Care. 2015;53(4 Suppl 1):S47–54. doi: 10.1097/MLR.0000000000000323.
    1. DeSalvo KB, Fan VS, McDonell MB, Fihn SD. Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005;40(4):1234–46. doi: 10.1111/j.1475-6773.2005.00404.x.
    1. Petterson SM, Liaw WR, Phillips RL, Jr, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med. 2012;10(6):503–9. doi: 10.1370/afm.1431.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren