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1.
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2.
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Julian Brunner Cindy L. Cain Elizabeth M. Yano Alison B. Hamilton 《Women's health issues》2019,29(1):64-71
Background
The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy.Methods
We conducted semistructured interviews with 86 local and regional women's health leaders at 12 VHA medical centers across four regions. At the conclusion of interviews about women's primary care, participants were asked to imagine “ideal care” for women veterans. Interviews were transcribed and coded using a hybrid inductive/deductive approach.Results
In describing ideal care, participants commonly touched on whether women veterans should have separate primary care services from men; the need for childcare, expanded reproductive health services, resources, and staffing; geographic accessibility; the value of input from women veterans; the physical appearance of facilities; fostering active interest in women's health across providers and staff; and the relative priority of women's health at the VHA.Conclusions
Policy and practice changes to care for women veterans must be mindful of key stakeholders' vision for that care. Specific features of that vision include clinic construction that anticipates a growing patient population, providing childcare and expanded reproductive health services, ensuring adequate support staff, expanding mechanisms to incorporate women veterans' input, and fostering a culture oriented towards women's health at the organizational level. 相似文献6.
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Galina A. Portnoy Sally G. Haskell Matthew W. King Rachel Maskin Megan R. Gerber Katherine M. Iverson 《Women's health issues》2018,28(5):439-445
Objectives
Veterans are at heightened risk for perpetrating intimate partner violence (IPV), yet there is limited evidence to inform practice and policy for the detection of IPV perpetration. The present study evaluated the accuracy and acceptability of a potential IPV perpetration screening tool for use with women veterans.Design
A national sample of women veterans completed a 2016 web-based survey that included a modified 5-item Extended-Hurt/Insult/Threaten/Scream (Modified E-HITS) and the Revised Conflict Tactics Scales (CTS-2). Items also assessed women's perceptions of the acceptability and appropriateness of the modified E-HITS questions for use in healthcare settings. Accuracy statistics, including sensitivity and specificity, were calculated using the CTS-2 as the reference standard.Main Outcome Measures
Primary measures included the Modified E-HITS (index test), CTS-2 (reference standard), and items assessing acceptability.Results
This study included 187 women, of whom 31 women veterans (16.6%) reported past-6-month IPV perpetration on the CTS-2. The Modified E-HITS demonstrated good overall accuracy (area under the curve, 0.86; 95% confidence interval, 0.78–0.94). In addition, the majority of women perceived the questions to be acceptable and appropriate.Conclusions
Findings demonstrate that the Modified E-HITS is promising as a low-burden tool for detecting of IPV perpetration among women veterans. This tool may help the Veterans Health Administration and other health care providers detect IPV perpetration and offer appropriate referrals for comprehensive assessment and services. 相似文献8.
Lisa S. Callegari Jodie G. Katon Kristen E. Gray Kemi Doll Sara Pauk Kristine E. Lynch Uchenna S. Uchendu Laurie Zephyrin Carolyn Gardella 《Women's health issues》2019,29(1):48-55
Background
In the general population, Black and Latina women are less likely to undergo minimally invasive hysterectomy than White women, which may be related to racial/ethnic variation in fibroid prevalence and characteristics. Whether similar differences exist in the Department of Veterans Affairs Healthcare System (VA) is unknown.Methods
Using VA clinical and administrative data, we identified all women veterans undergoing hysterectomy for benign indications in fiscal years 2012–2014. We identified hysterectomy route (laparoscopic with/without robot-assist, vaginal, abdominal) by International Classification of Diseases, 9th edition, codes. We used multinomial logistic regression to estimate associations of race/ethnicity with hysterectomy route and tested whether associations varied by fibroid diagnosis using an interaction term. Models adjusted for age, income, body mass index, gynecologic diagnoses, medical comorbidities, whether procedure was performed or paid for by VA, geographic region, and fiscal year.Results
Among 2,744 identified hysterectomies, 53% were abdominal, 29% laparoscopic, and 18% vaginal. In multinomial models, racial/ethnic differences were present among veterans with but not without fibroid diagnoses (p value for interaction < .001). Among veterans with fibroids, Black veterans were less likely than White veterans to have minimally invasive hysterectomy (laparoscopic vs. abdominal relative risk ratio [RRR], 0.52; 95% CI, 0.38–0.72; vaginal vs. abdominal RRR, 0.58; 95% CI, 0.43–0.73). Latina veterans were as likely as White veterans to have laparoscopic as abdominal hysterectomy (RRR, 1.34; 95% CI, 0.87–2.07) and less likely to have vaginal than abdominal hysterectomy (RRR, 0.32; 95% CI, 0.15–0.69).Conclusions
Receipt of minimally invasive hysterectomy among women veterans with fibroids varied by race/ethnicity. Further investigation of the underlying mechanisms and potential interventions to increase minimally invasive hysterectomy among minority women veterans is needed. 相似文献9.
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10.
Kimberly Narain Bevanne Bean-Mayberry Donna L. Washington Ismelda A. Canelo Jill E. Darling Elizabeth M. Yano 《Women's health issues》2018,28(3):267-272
Background
Food insecurity has been associated with worse health outcomes in the civilian population. Male veterans of the Gulf Wars have been shown to have a higher prevalence of food insecurity than similarly situated civilians. Women veterans have more risk factors for food insecurity, relative to male veterans, yet little is known about the prevalence of food insecurity in this cohort.Methods
We used the Women Veterans' Health Utilization and Experience Survey for this analysis. Our study population consisted of women veterans who had at least three primary care or women's health visits to 1 of 12 Veteran's Health Administration health care facilities from December 2013 to November 2014. Multiple logistic regression was used to examine the relationship between food insufficiency (an inadequate amount of food intake owing to a lack of money or resources), delayed/missed care, anxiety, depression, and self-reported fair to poor health, controlling for race/ethnicity, marital status, and employment status.Results
The prevalence of food insufficiency among women veterans was 27.6%. Being food insufficient was associated with 16.4, 15.4, 14.9, and 12.1 percentage point increases in the probability of delayed/missed care, screening positive for anxiety, screening positive for depression, and reporting fair to poor health, respectively (p < .05).Conclusions
The prevalence of food insufficiency in this cohort was associated with delayed access to health care and worse health outcomes. Interventions addressing Veterans Administration access and health outcomes will need to examine the potential role of food insufficiency. 相似文献11.
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12.
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13.
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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15.
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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17.
Background
Obesity is recognized as a barrier to receiving women's preventive health services, including cervical and breast cancer screening. Little is known about whether obesity is associated with a lower incidence of human papillomavirus (HPV) vaccination, another important preventive care service for adolescent girls and young women. The objective of this study was to determine if adolescent girls and young women with obesity are less likely to receive HPV vaccination compared with individuals with normal weight.Methods
We examined whether HPV vaccination was associated with obesity status in women aged 9–30 years surveyed from 2009 to 2016 by the U.S. National Health and Nutrition Examination Survey. Results from logistic and linear regression models were adjusted for age, race, income, insurance status, self-reported health, and health care use, accounting for the weighted survey design.Results
The final cohort included 5,517 women. Overall, 32.9% of participants reported vaccination, with a mean age at vaccination of 15.8 years. Adolescent girls and young women with obesity were less likely to report vaccination; the adjusted odds ratio of vaccination was 0.79 (p = .01) compared with normal weight women. Among those vaccinated, the age at vaccination was significantly older for women with obesity, 16.3 years compared with 15.2 years (p = .002), but there was no difference in the completion of the vaccination series rate by obesity.Conclusions
Adolescent girls and young women with obesity were less likely to report HPV vaccination and, if they were vaccinated, received the vaccination at a later age. 相似文献18.
Katie Woodruff 《Women's health issues》2019,29(1):80-86
Background and Objectives
News coverage can shape public understanding of policy issues in important ways. In the last decade, many new state-level abortion restrictions have been passed, often based on claims about the safety of abortion care, yet little is known about recent news coverage of abortion. This study analyzes a sample of news on abortion in the United States and explores the implications for reproductive health policymakers, practitioners, and advocates.Methods
We analyzed a sample of news and opinion articles containing the term “abortion” published in three major U.S. newspaper sources in 2013 and 2016. The total sample was 783 unique pieces. We coded for story topics, references to fetal personhood, women's stories, and basic abortion facts. Three trained coders conducted the coding, with intercoder reliability rates ranging from 0.777 to 1.0.Findings
Most of the time abortion appears in the news, it is merely mentioned, rather than discussed substantively. Abortion is covered as a political issue more than a health issue. The personal experiences of people who get abortions are present in only 4% of the sample, and language personifying the fetus appears more often than women's abortion stories. State abortion restrictions are newsworthy, yet basic facts on the commonality and safety of abortion are virtually absent.Conclusions
This study suggests that the news does not support public understanding of abortion as a common, safe part of reproductive health care. Such framing may undermine public support for policies that protect access to this common health care service. 相似文献19.
Caroline Heller Krista M. Perreira Adele Shartzer Emily M. Johnston Brigette Courtot 《Women's health issues》2019,29(2):161-169
Objectives
Given persistent racial/ethnic disparities in unintended pregnancies, this study aims to understand factors associated with emergency contraception (EC) use among non-Hispanic White, non-Hispanic Black, and Hispanic women.Methods
This study used a nationally representative sample of 1,990 women of reproductive age in the United States who participated in the 2016 Survey of Family Planning and Women's Lives. Logistic regressions were estimated to assess the association of sexual/pregnancy history, attitudes toward pregnancy, attitudes toward contraception, awareness and beliefs about EC, and source of information regarding contraception with ever using EC.Results
After adjusting for demographic characteristics, we found no significant differences in ever using EC by race/ethnicity. Among non-Hispanic White women, those who used barrier methods of contraception, reported a previous unplanned pregnancy, reported having heard some or a lot about EC, and believed that EC is somewhat to very effective had higher odds of EC use. Among non-Hispanic Black women, those who reported a previous unplanned pregnancy and believed that EC was somewhat to very effective had higher odds of EC use. Among Hispanic women, those who reported using long-acting reversible contraceptives, having recent male sexual partners, and believing that EC is both somewhat to very safe and effective had higher odds of EC use.Conclusions
Awareness and beliefs about safety and effectiveness are modifiable factors that may influence EC use. Population-level interventions can focus on improving awareness and understanding of the safety and effectiveness of EC. 相似文献20.
Julian Brunner Emmeline Chuang Donna L. Washington Danielle E. Rose Catherine Chanfreau-Coffinier Jill E. Darling Ismelda A. Canelo Elizabeth M. Yano 《Women's health issues》2018,28(2):165-171