Understanding Gender Sensitivity of the Health Care Workforce at the Veterans Health Administration

BackgroundGender sensitivity of providers and staff has assumed increasing importance in closing historical gender disparities in health care quality and outcomes. The Department of Veterans Affairs (VA) has implemented several initiatives intended to improve gender sensitivity of its health care workforce. The current study examines practice- and individual-level characteristics associated with gender sensitivity of primary care providers (PCPs) and staff.MethodsWe surveyed PCPs and staff (nurses, medical assistants, and clerks) at 12 VA medical centers (VAMCs) (n = 256 of 649; response rate, 39%). Gender sensitivity was measured using a 10-item scale adapted from the Gender Awareness Inventory-VA. We used weighted multivariate regression with maximum likelihood estimation to identify individual- and practice-level characteristics associated with gender sensitivity of PCPs and staff.ResultsPCPs and staff had similar gender sensitivity but differed in most characteristics associated with that gender sensitivity. Among PCPs, women's health training and positive communication with others in the clinic were associated with greater gender sensitivity. For staff, prior work experience caring for women, working in Women's Health Patient-Aligned Care Teams, and rural location were associated with greater gender sensitivity, whereas more years of VA service was associated with lower gender sensitivity. Working at VA medical centers with a higher volume of women veteran patients was associated with greater gender sensitivity for both PCPs and staff.ConclusionsWomen's health training and experience in working with other women's health professionals are strongly correlated with greater gender sensitivity in the clinical workforce.     

Redesigning a School Health Workforce for a New Health Care Environment: Training School Nurses as Nurse Practitioners

ABSTRACT: Diminishing financial resources for school health dictate the most efficient possible deployment of the school health workforce. School nurses trained as nurse practitioners could help resolve the common problems of ready access to and appropriate use of primary care, early detection of potentially costly medical problems, and efficient use of school health staff. To determine how best to use existing resources to meet the increasingly varied and complex health care needs of children and adolescents, a pilot project was conducted in Denver from 1994 to 1996. With physician back-up and health aide support, school nurses were trained as nurse practitioners to provide in-school diagnostic and treatment services. Based on their evaluation study of this pilot project, the authors suggest ways to solve problems in role transition, including well-balanced training; clear role definition and assignment of responsibilities; appropriate back-up and mentoring support; and issues of sustaining long-term programs     

The Changing Role of Families in Health Care

In the last fifty years while there have been dramatic changes in the science and technology of pediatrics there have also been major changes in the participation of families in child health care Since its founding, ACCH has helped to shape these changes and will continue this leadership in addressing the challenges of the 1990's.     

The Changing Role of Families in Health Care

In the last fifty years while there have been dramatic changes in the science and technology of pediatrics there have also been major changes in the participation of families in child health care Since its founding, ACCH has helped to shape these changes and will continue this leadership in addressing the challenges of the 1990's.     

The Role of the Health Care System in Primordial Prevention

The health care system has the resources to assume an important role in primordial prevention. The extent to which it does so will be determined largely by the financial and economic forces that are transforming the health care system. There is reason to be optimistic about the effectiveness of a partnership between community-based organizations and medical centers in addressing the challenges of primordial prevention in the 21st century.     

The Role of Community Health Centers in Providing Behavioral Health Care

The prevalence of behavioral health problems is higher for low-income individuals, yet this population is less likely to receive behavioral health treatment. Community health centers have their advantages as behavioral health-care providers because they serve a majority low-income population and are located in medically underserved areas. Their role in providing behavioral health care is expected to expand under health reform as they are expected to double their patient capacity, and due to increased insurance coverage for individuals with behavioral health problems. However, the ability of community health centers to provide behavioral health care is compromised by provider shortages and funding shortfalls.     

保健科在医院干部保健工作中的作用

保健科是医院中具有职能作用的保健专业管理科室.在医院干部保健工作中,发挥着沟通协调、窗口形象、调解医患矛盾等作用.在工作中应注意加强科室自身建设,善于总结工作经验,不断开拓创新.     

The Role of Stigma and Medical Mistrust in the Routine Health Care Engagement of Black Men Who Have Sex With Men

Objectives. We assessed how health care–related stigma, global medical mistrust, and personal trust in one’s health care provider relate to engaging in medical care among Black men who have sex with men (MSM).Methods. In 2012, we surveyed 544 Black MSM attending a community event. We completed generalized linear modeling and mediation analyses in 2013.Results. Twenty-nine percent of participants reported experiencing racial and sexual orientation stigma from heath care providers and 48% reported mistrust of medical establishments. We found that, among HIV-negative Black MSM, those who experienced greater stigma and global medical mistrust had longer gaps in time since their last medical exam. Furthermore, global medical mistrust mediated the relationship between stigma and engagement in care. Among HIV-positive Black MSM, experiencing stigma from health care providers was associated with longer gaps in time since last HIV care appointment.Conclusions. Interventions focusing on health care settings that support the development of greater awareness of stigma and mistrust are urgently needed. Failure to address psychosocial deterrents will stymie progress in biomedical prevention and cripple the ability to implement effective prevention and treatment strategies.The HIV epidemic is one of the most critical public health issues facing the United States today. Although HIV infections are documented among all racial/ethnic and sexual risk groups, Black men who have sex with men (Black MSM) are the most affected by HIV in the United States.1 Forty-four percent of new HIV infections are among Blacks, and the rate of HIV infection among this group is 7.9 times higher than is the rate of HIV infections among Whites. Black MSM, in particular, are diagnosed with HIV at a rate 6.0 times higher than that of White MSM, and they are 3.8 times more likely to be living with HIV than are White MSM.2 The remarkable HIV-related race/ethnicity and sexual orientation disparities observed among Black MSM require urgent attention.Although surveillance regarding HIV infection highlights increases in HIV transmission among Black MSM, in particular young Black MSM, there is considerable promise in emerging and available HIV prevention and treatment options (e.g., microbicides,3 preexposure prophylaxis,4 and treatment as prevention5). However, these approaches to HIV prevention require engagement in routine medical care and HIV treatment–related care. The use of biomedical technologies in preventing the spread of HIV will fail if those in need are not connected to care that can facilitate access to and monitor the use of these strategies.6,7Within the current HIV prevention and treatment health care landscape, it is well understood that HIV-positive Black MSM who are without engagement in care suffer worse morbidities and greater mortality than do those in care and that overall rates of engagement in care must be improved.8–10 Likewise, we know very little about the routine health care of HIV-negative Black MSM.11,12 Limited previous research has found that Black MSM describe their experiences of engaging in health care as fragmented and their health care services offered as subpar.13 The inadequate screening and treatment of sexually transmitted infection and HIV are observed even for routine sexually transmitted infection and HIV care among HIV-negative Black MSM.14 Consequently, failure to engage HIV-negative Black MSM in care results in missed opportunities to provide them with prevention options.Theoretically, there are multiple factors to consider when examining the limited retention to care that we observe among Black MSM.15–18 Notably, being uninsured or underinsured, limitations because of location and transportation, and lack of available qualified health professionals are factors directly related to access.19 However, psychosocial deterrents to care are equally important and impede health care access as well.20–23 For instance, stigma, described as the social devaluation or discrediting associated with a specific characteristic or attribute,24 and trust in health care providers and medical establishments are linked to health care behaviors.25 We focused on these psychosocial factors.Research in the area of psychosocial-related deterrents to seeking health care has highlighted the need to better understand the role of stigma in health care access26–28—in particular, the role of enacted stigma (or experiences of discrimination) in health care settings. Institutions that are mandated to protect the well-being of Black MSM are in many instances perceived as threatening to them as a result of experiencing health care provider sexual-orientation and HIV-status discrimination.29,30 Furthermore, in a review of stigma and the HIV epidemic, Mahajan et al. highlight the lack of data on measuring the effects of overlapping stigmas (in the case of Black MSM, being part of a racial and sexual orientation minority) on accessing health care.25 Not only can stigma undermine access to care, but it is also associated with longer breaks in care among those who have been linked.6,9,10 Therefore, previous research warrants an assessment of the extent to which Black MSM experience enacted stigmas and how these experiences are related to accessing medical care.Medical mistrust among Black adults has also been identified as a barrier to engaging in routine health care. Beliefs regarding mistrust in the treatment of HIV in particular are especially damaging to clinicians’ abilities to engage those in need of care.31,32 Trust in health care providers has been directly linked to health outcomes such as antiretroviral adherence and good mental health.32 However, few studies have investigated the role of medical mistrust among MSM, and limited data on Black MSM exist on this topic.33 The available literature generally presents 2 focus assessments when assessing medical mistrust: (1) a system focus assessment, that is, general trust in medical establishments; and (2) an individual focus assessment, that is, trust in a provider’s ability to offer adequate care.34–37 These concepts are thought to affect one’s likelihood of seeking out (system focus) and staying in (individual focus) care. However, research on these areas is limited and exploratory in nature.We sought to understand how experiences of health care–enacted stigma relate to accessing routine medical care among HIV-negative and HIV-positive Black MSM attending a community event in Atlanta, Georgia. Furthermore, we examined the association of this relationship with global medical mistrust and personal trust in one’s health care provider. We hypothesized that experiences of enacted health care stigma would predict routine care and that this relationship would be mediated by perceptions of medical mistrust among HIV-positive and -negative Black MSM.     

The Role of Primary Care in Improving Population Health

Policy Points

• Systems based on primary care have better population health, health equity, and health care quality, and lower health care expenditure.
• Primary care can be a boundary-spanning force to integrate and personalize the many factors from which population health emerges.
• Equitably advancing population health requires understanding and supporting the complexly interacting mechanisms by which primary care influences health, equity, and health costs.

     

The Role of Consumers in Health Care Decision Making

This paper focuses on the results of a survey of chief executive officers and consumer board members of Ontario hospitals and community health centres regarding the role of consumers in health care decision making. The opinions of both the chief executive officer and consumer board member respondents were elicited regarding the value of consumer input in decision making for the organizations studied. Results indicate that consumer board members feel that their input into organizational decision making is valued, chief executive officers value the input of consumers, and consumer involvement in decision making is increasing. More women are now involved on boards of the organizations studied, but visible minority representation remains low on hospital boards. Consumer board members feel that their decision making is influenced by providers on the board.     

Health Care Marketing's Role in the Future

No abstract available for this article.