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Donna L. Washington Marjorie Danz LaShawnta Jackson Kristina M. Cordasco 《Women's health issues》2019,29(2):135-143
Background
Abnormal uterine bleeding (AUB) is a common women's health complaint. However, the quality of primary care (PC) management of AUB is unknown. Our objective was to develop quality indicators for Veterans Health Administration (VA) PC assessment and management of AUB.Methods
We drafted candidate indicators based on comprehensive review of the scientific literature, including published consensus guidelines. Then, we convened a national panel of nine experts including PC providers, obstetrician-gynecologists, VA policy stakeholders, and quality measurement experts, and used a modified Delphi panel process. First, panelists individually rated 19 candidate indicators, using 9-point scales, on three metrics: consistency with established guidelines, importance to women's health, and reliability of measurement from VA electronic health records. Panelists then discussed the indicators. Finally, panelists re-rated revised indicators using the same metrics. Indicators were selected if final median ratings were ≥7 on each 9-point scale, without dispersion in ratings.Results
Eighteen indicators were selected. Three focused on assessing need for emergency care (e.g., profuse bleeding or pregnancy). Three addressed ascertaining key aspects of the medical history (e.g., endometrial cancer risk). Two addressed performing a physical examination (e.g., pelvic examination). Six addressed indications for diagnostic studies and specialty care referrals, (e.g., transvaginal ultrasound examination). Four addressed initiation of treatment and counseling (e.g., hormone therapy).Conclusions
We developed quality indicators for PC assessment and management of AUB that span reproductive and postmenopausal life phases. Applying these indicators in VA and other health systems with integrated electronic health records can assess need for, and effects of, AUB quality improvement programs. 相似文献5.
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Introduction
Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid programs and the private health insurance plans in their service areas to provide high-quality contraceptive care to the millions of women relying on services at these sites annually.Methods
We collected survey data from a nationally representative sample of 535 clinics providing family planning services that received Title X funding and conducted semistructured interviews with 23 administrators at a subsample of surveyed clinics to explore provider-reported experiences working with health plans and to identify barriers to, and practices that lead to, adequate reimbursement for services provided.Results
Providers report that knowledgeable staff are crucial to securing contracts with both public and private insurance plan issuers, and that the contracts they secure often include coverage restrictions on methods or services clinics offer their clients. Good staff relationships with issuers are key to obtaining adequate and consistent reimbursement for all covered services.Conclusions
Providers are trying to understand how insurance programs in their area knit together. Regardless of how U.S. health policies and delivery systems may change in the coming years, it is imperative that publicly funded family planning centers continue to work with health plans and maximize their third-party revenue to provide services to those in need. 相似文献8.
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Kristina M. Cordasco Anita H. Yuan Marjorie J. Danz Melissa M. Farmer LaShawnta Jackson Ellen F. Yee Donna L. Washington 《Women's health issues》2019,29(2):144-152
Background
Abnormal uterine bleeding (AUB) is common among primary care patients. We assessed the extent to which Veterans Health Administration (VA) primary care patients with AUB are receiving guideline-adherent primary care.Methods
We identified women with AUB presenting to primary care providers across four VA health care systems from June 2013 to September 2015. We performed a structured abstraction of electronic medical record data for 15 indicators of guideline-adherent AUB care. We determined whether documented care was guideline-adherent and compared adherence of care by primary care providers by VA Designated Women's Health Provider status and by volume of clinical encounters with women veterans.Results
Across 305 episodes of AUB, 53% of the care was guideline adherent. There was high adherence with documenting menopausal status (98%), ordering diagnostic studies and referrals for postmenopausal women (92%), and documenting bleeding patterns (87%). There was lower adherence with documenting whether there was active bleeding (55%), performing thyroid testing (47%), performing a pelvic examination (42%), ordering diagnostic studies and referrals in younger women with increased endometrial cancer risk (40%), assessing for pregnancy (32%), assessing for cervical motion, uterine, or adnexal tenderness in patients with intrauterine devices (30%), and assessing for elevated endometrial cancer risk (6%). There were no significant differences in overall guideline adherence between primary care providers who were, versus were not, VA Designated Women's Health Providers, or by provider volume of encounters with women veterans.Conclusions
VA primary care has high guideline adherence when caring for postmenopausal women with AUB. Quality improvement and educational initiatives are needed to improve primary care for AUB in younger women veterans. 相似文献10.
Catherine Chanfreau-Coffinier Howard S. Gordon C. Amanda Schweizer Bevanne A. Bean-Mayberry Jill E. Darling Ismelda Canelo Elizabeth M. Yano 《Women's health issues》2018,28(5):430-438
Background
Identifying factors influencing patient experience and communication with their providers is crucial for tailoring comprehensive primary care for women veterans within the Veterans Health Administration. In particular, the impact of mental health (MH) conditions that are highly prevalent among women veterans is unknown.Methods
From January to March 2015, we conducted a cross-sectional survey of women veterans with three or more primary care and/or women's health visits in the prior year at 12 Veterans Health Administration sites. Patient measures included ratings of provider communication, trust in provider, and care quality; demographics, health status, health care use; and brief screeners for symptoms of depression, anxiety, and posttraumatic stress disorder. We used multivariate models to analyze associations of patient ratings and characteristics.Results
Among the 1,395 participants, overall communication ratings were high, but significant variations were observed among women screening positive for MH conditions. In multivariate models, high communication ratings were less likely among women screening positive for multiple MH conditions compared with patients screening negative (odds ratio, 0.43; p < .001). High trust in their provider and high care ratings were significantly less likely among women with positive MH screens. Controlling for communication, the effect of MH on trust and care ratings became less significant, whereas the effect of communication remained highly significant.Conclusions
Women veterans screening positive for MH conditions were less likely to give high ratings for provider communication, trust, and care quality. Given the high prevalence of MH comorbidity among women veterans, it is important to raise provider awareness about these differences, and to enhance communication with patients with MH symptoms in primary care. 相似文献11.
Barrot H. Lambdin Megan Comfort Alex H. Kral Jennifer Lorvick 《Women's health issues》2018,28(5):470-475
Background
Jail is frequently described as a “revolving door,” which can be profoundly destabilizing to people moving in and out of the system. However, there is a dearth of research attempting to understand the impacts of the accumulation of incarceration events on women who use drugs. We examined the association of the frequency of jail incarceration with hardship, perceived health status, and unmet health care need among women who use drugs.Methods
Our community-based sample included women who use heroin, methamphetamine, crack cocaine, and/or powder cocaine (N = 624) in Oakland, California, from 2012 to 2014. Poisson regression models with robust variances were built to estimate adjusted prevalence ratios between the frequency of jail incarcerations and measures of hardship, perceived health, and unmet health care need, adjusting for a set of a priori specified covariates.Results
We observed associations between high levels of jail frequency and higher levels of homelessness (p = .024), feeling unsafe in their living situation (p = .011), stress (p = .047), fair to poor mental health (p = .034), unmet mental health care need (p = .037), and unmet physical health care need (p = .041). We did not observe an association between jail frequency and unmet subsistence needs score or fair to poor physical health.Conclusions
We observed associations between higher levels of jail frequency and a higher prevalence of hardship, poor mental health, and unmet health care need. Our findings suggest areas for additional research to untangle the impacts of frequent incarceration on women's health and well-being. 相似文献12.
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Background
A large body of research has documented disparities in health and access to care among sexual minority populations, but very little population-based research has focused on the health care needs among pregnant sexual minority women.Methods
Data for this study came from 3,901 reproductive-age (18–44 years) women who identified as lesbian or bisexual and 63,827 reproductive-age women who identified as heterosexual in the 2014–2016 Behavioral Risk Factor Surveillance System. Logistic regression models were used to compare health care access, health outcomes, and health behaviors by sexual orientation and pregnancy status while controlling for demographic characteristics and socioeconomic status.Results
Approximately 3% of reproductive-age sexual minority women were pregnant. Pregnant sexual minority women were more likely to have unmet medical care needs owing to cost, frequent mental distress, depression, poor/fair health, activity limitations, chronic conditions, and risky health behaviors compared with pregnant heterosexual women. Nonpregnant sexual minority women were more likely to report barriers to care, activity limitations, chronic conditions, smoking, and binge drinking compared with nonpregnant heterosexual women. Health outcomes were similar between pregnant and nonpregnant sexual minority women, but pregnant sexual minority women were more likely to smoke cigarettes every day compared with other women.Conclusions
This study adds new population-based research to the limited body of evidence on health and access to care for pregnant sexual minority women who may face stressors, discrimination, and stigma before and during pregnancy. More research and programs should focus on perinatal care that is inclusive of diverse families and sexual orientations. 相似文献14.
Lisa A. Martin Jane A. Hassinger Meghan Seewald Lisa H. Harris 《Women's health issues》2018,28(1):59-67
Objectives
We report on the development of a scale measuring abortion providers’ experiences of stigma.Study Design
Using previous measures, qualitative data, and expert review, we created a 49-item question pool. We administered questions to 315 abortion providers before participation in the Providers Share Workshop. We explored the factor structure and item quality using exploratory factor analysis. We assessed reliability using Cronbach's alpha. To test construct validity, we calculated Pearson's correlation coefficients between the stigma scales, the Maslach Burnout Inventory, and the K10 measure of psychological distress. We used Stata SE/12.0 for analyses.Results
Factor analysis revealed a 35-item, five-factor model: worries about disclosure, internalized states, social judgment, social isolation, and discrimination (Cronbach's alphas 0.79–0.94). Our stigma measure was correlated with psychological distress (r = 0.40; p < .001), and with Maslach Burnout Inventory's emotional exhaustion (r = 0.27; p < .001), and depersonalization (0.23; p < .001) subscales, and was inversely correlated with Maslach Burnout Inventory's personal accomplishment subscale (r = ?0.15; p < .05).Conclusions
Psychometric analysis of this scale reveals that it is a reliable and valid tool for measuring stigma in abortion providers, and may be helpful in evaluating stigma reduction programs. 相似文献15.
Martina T. Caldwell Hwajung Choi Phillip Levy Vanessa K. Dalton Dawn Phillips Misra 《Women's health issues》2018,28(4):306-312
Introduction
Women using emergency departments (ED) or urgent care facilities for their usual care may lack access to contraception. This study examined the relationship between effectiveness of current contraception use (highly effective/effective methods vs. less effective/no method) and usual source of care in the clinic (referent group), urgent care, ED, or none among U.S. reproductive-aged females at risk for unintended pregnancy.Methods
Using the National Survey of Family Growth, we conducted logistic regression analyses using pooled, as well as age- and insurance-stratified, data.Results
Less effective/no contraception was associated with ED (odds ratio [OR] = 1.9 [95% CI = 1.3, 3]) and no usual source of care (OR = 1.5 [95% CI = 1.3, 1.8]) in the unadjusted logistic regression. Adjusting for confounders, no usual care source was marginally associated with less effective/no contraception use (OR = 1.2 [95% CI = 1.0, 1.4]; p = .041). Adjusted age- and insurance-stratified analyses revealed that less effective/no contraception was associated with the following: no usual care source for 15 to 19-year-olds (OR = 2.5, [95% CI = 1.5, 4.1]); ED usual care source for 20 to 25-year-olds (OR = 2.2, [95% CI = 1.0, 4.5]; p = .038); ED usual care source for Medicaid/Children’s Health Insurance Program-insured (OR = 2.0, [95% CI = 1.0, 3.7]; p = .042); and ED usual care source for any publicly-funded insurance (adjusted OR = 2.1, [95% CI = 1.1, 3.8]).Conclusion
Overall, use of less effective/no contraception did not vary substantially by usual source of care. Stratified analyses showed some groups of women with ED usual source of care (20 to 25-year-olds, Medicaid/Children’s Health Insurance Program insurance, or any publicly-funded insurance) and no usual care source (15 to 19-year-olds) had higher odds of using less effective/no contraception. 相似文献16.
Background
Little research documents the self-identified reproductive health priorities and health care experiences of lesbian, gay, bisexual, transgender, queer (LGBTQ)-identified individuals who may be in need of services.Methods
We conducted in-depth interviews with a diverse sample of 39 female-assigned-at-birth individuals (ages 18–44) who also identified as lesbian, bisexual, queer, and/or genderqueer, or transmasculine. Interviews were primarily conducted in person in the Bay Area of California, and Baltimore, Maryland, with 11 conducted remotely with participants in other U.S. locations. We asked participants about their current reproductive health care needs, topics they felt researchers should pursue, and past reproductive health care experiences. Data were analyzed using a framework method, incorporating deductive and inductive thematic analysis techniques.Results
Reproductive health care needs among participants varied widely and included treatment of polycystic ovary syndrome and irregular menses, gender-affirming hysterectomies, and fertility assistance. Many faced challenges getting their needs met. Themes related to these challenges cross-cutting across identity groups included primary focus on fertility, provider lack of LGBTQ health competency relevant to reproductive health priorities and treatment, and discriminatory comments and treatment. Across themes and identity groups, participants highlighted that sexual activity and reproduction were central topics in reproductive health care settings. These topics facilitated identity disclosures to providers, but also enhanced vulnerability to discrimination.Conclusions
Reproductive health priorities of LGBTQ individuals include needs similar to cisgender and heterosexual groups (e.g., abortion, contraception, PCOS) as well as unique needs (e.g., gender affirming hysterectomies, inclusive safer sex guidance) and challenges in pursuing care. Future reproductive health research should pursue health care concerns prioritized by LGBTQ populations. 相似文献17.
Tierney Wolgemuth Colleen Judge-Golden Lisa Callegari Xinhua Zhao Maria Mor Sonya Borrero 《Women's health issues》2018,28(6):480-487
Background
Although pregnancy intention is strongly associated with contraceptive use, little is known about the interaction between pregnancy intention and attitude, or how they jointly affect contraceptive use.Methods
Cross-sectional data from a national survey of women veterans who receive care within the Veterans Affairs Healthcare System were used to examine relationships among pregnancy intention (in next year, in >1 year, never, not sure), attitude toward hypothetical pregnancy (worst thing, neutral, best thing), and contraceptive use among women at risk for unintended pregnancy. Bivariate and multivariable analyses assessed associations between pregnancy intention and attitude, both separately and jointly, with contraceptive use. Multinomial regression assessed the relationship of intention and attitude with contraceptive method effectiveness.Results
Among 858 women at risk of unintended pregnancy, bivariate analysis demonstrated that pregnancy intention and attitude were associated, but not perfectly aligned. In logistic regression models including both variables, intention of never versus in next year (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.34–5.75) and attitude of worst thing versus best thing (aOR, 2.86; 95% CI, 1.42–5.74) were each positively associated with contraception use. Among women using contraception, intention of never (aOR, 3.17; 95% CI, 1.33–7.59) and attitude of worst thing (OR, 2.09; 95% CI, 1.05–4.17) were associated with use of highly effective (e.g., intrauterine devices and implants) versus least effective (e.g., barrier) methods.Conclusions
These findings support prior research suggesting that pregnancy intention alone does not fully explain contraceptive behaviors and imply that attitude toward pregnancy plays an important role in shaping contraceptive use independent of pregnancy intentions. 相似文献18.
Julie Chor Sarah Garcia-Ricketts Danielle Young Luciana E. Hebert Lee A. Hasselbacher Melissa L. Gilliam 《Women's health issues》2018,28(5):387-392
Objectives
This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act.Methods
We conducted semistructured interviews with low-income women presenting for induced abortion who lacked a well-woman visit in more than 12 months or a regular health care provider. Dimensions explored included 1) pre-abortion experiences seeking WWC, 2) postabortion plans for obtaining WWC, and 3) perceived barriers and facilitators to obtaining WWC. Interviews were transcribed and analyzed using ATLAS.ti.Results
Thirty-four women completed interviews; three-quarters were insured. Women described interacting psychosocial, interpersonal, and structural barriers hindering WWC use. Psychosocial barriers included negative health care experiences, low self-efficacy, and not prioritizing personal health. Women's caregiver roles were the primary interpersonal barrier. Most prominently, structural challenges, including insurance insecurity, disruptions in patient–provider relationships, and logistical issues, were significant barriers. Perceived facilitators included online insurance procurement, care integration, and social support.Conclusions
Despite most being insured, participants encountered WWC barriers after implementation of the Affordable Care Act. Further work is needed to identify and engage women lacking preventive reproductive health care. 相似文献19.
Kathryn M. Nowotny Anastasiia Kuptsevych-Timmer Carrie Oser 《Women's health issues》2019,29(2):125-134
Background
It is well-established in the United States that incarceration negatively influences women's health, and researchers have called for examinations of the health effects of criminal justice contact more broadly. This study uses the behavioral model for vulnerable populations to document the prevalence of illness and health risks for recently arrested women, and examines potential ways that illness and health risks are associated with health service use across health care settings.Methods
We conducted a mediation analysis using pooled data from the National Survey on Drug Use and Health (2010–2014).Results
These findings reveal that recent arrest is associated with different types of health care use among women. Specifically, women recently arrested are hospitalized and seek care at the emergency department at higher rates than non–recently arrested women and this may be associated with their vulnerable mental and behavioral health status.Conclusions
The findings suggest an increasing overlap between criminal justice and public health sectors. Increased access to appropriate health services is a necessary strategy to reduce resource intensive hospitalizations and emergency department use among women experiencing a recent arrest. 相似文献20.