Predictors of Veterans Affairs Health Service Utilization by Women Veterans during Pregnancy |
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| Institution: | 1. Ann Arbor VA Healthcare System, Ann Arbor, Michigan;2. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan;3. Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan;4. Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan;5. VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts;6. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts;1. Thoracic Service, Department of Surgery, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York;3. Department of Epidemiology and Biostatistics, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York;4. Thoracic Oncology Service, Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York;5. Nuclear Medicine Service, Department of Radiology, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York;2. Weill Cornell Medical College, New York, New York;1. U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington;2. Department of Health Services, University of Washington, Seattle, Washington;3. Department of Obstetrics and Gynecology, University of Washington, School of Medicine, Seattle, Washington;4. Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, Seattle, Washington;5. Women''s Health, VA Boston Healthcare System, Boston, Massachusetts;6. Department of Medicine, Boston University School of Medicine, Boston, Massachusetts;7. VA Salt Lake City Health Care System, Salt Lake City, Utah;8. Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah;1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina;2. Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina;3. VA Connecticut Healthcare System, West Haven, Connecticut;4. Department of Medicine, Yale University, New Haven, Connecticut;5. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina;6. Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina;7. VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California;8. Geffen School of Medicine, University of California Los Angeles, Los Angeles, California;1. RAND Corporation, Santa Monica, California;2. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California;3. Pardee RAND Graduate School, Santa Monica, California;4. USC Center for Economic and Social Research, Los Angeles, California;5. National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, Massachusetts;6. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts;7. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California |
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| Abstract: | BackgroundResearchers have examined predictors of Veterans Affairs (VA) service use by women veterans in general, but less is known about predictors of VA service use by pregnant veterans. This study examined characteristics associated with planned and actual VA service use by pregnant veterans.MethodsThis study includes data from 510 pregnant veterans enrolled in the Center for Maternal and Infant Outcomes Research in Translation Study. Women veterans completed phone interviews during their first trimester and at 3 months postpartum. The Center for Maternal and Infant Outcomes Research in Translation surveys assessed medical and mental health conditions, VA health care use, trauma history, and pregnancy complications. We conducted bivariate and multivariable logistic regression models assessing planned and actual use of VA services during pregnancy.ResultsLifetime post-traumatic stress disorder (odds ratio OR], 1.73; 95% confidence interval CI], 1.11–2.69) and history of military sexual trauma (OR, 1.85; 95% CI, 1.19–2.87) were significantly associated with planned VA service use in multivariable models. Lifetime diagnoses of anxiety (OR, 1.78; C.I., 1.15–2.75) were associated with an increased likelihood of actual VA use during pregnancy, whereas Hispanic ethnicity (OR, 0.59; 95% CI, 0.36–0.96), younger age (OR, 0.95; 95% CI, 0.91–0.99), and access to private health insurance (OR, 0.55; 95% CI, 0.37–0.84) were associated with a decreased likelihood of actual VA service use during pregnancy.ConclusionsResults emphasize the association between high-risk mental health characteristics and specific demographic characteristics with VA service use among pregnant veterans. Study findings highlight a continued need for women's health care at the VA, as well as the availability of VA providers knowledgeable about perinatal health issues, and informed community providers regarding women veterans' health. |
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