Toward a VA Women's Health Research Agenda: Setting Evidence‐based Priorities to Improve the Health and Health Care of Women Veterans

Duke University, Durham, NC, USA
Journal of General Internal Medicine (Impact Factor: 3.42). 02/2006; 21(S3):S93 - S101. DOI: 10.1111/j.1525-1497.2006.00381.x
Source: PubMed


The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research.

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Available from: Paula Schnurr
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    • "The primary care provider should, in the context of a longitudinal relationship, fulfill all primary care needs… " (Department of Veterans Affairs 2010b, p. 2). Making comprehensive women'sh e al t h care widely available has been challenging due to small caseloads at some sites (Yano et al. 2006). Additionally, many VHA providers have not been routinely caring for women during their VHA careers and lack the ability to provide gender-specific services (i.e., care that is dictated by gender, such as pelvic examinations and pap smears). "
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    ABSTRACT: Female Veterans experience intimate partner violence (IPV) at alarming rates. The Veterans Health Administration (VHA) requires foundational research to guide the development of policy and programs to detect IPV among women Veterans and provide interventions. This pilot study reports findings from in-depth qualitative interviews conducted with 12 VHA primary care providers treating female Veterans in the New England region. Although most providers indicated that they were not currently routinely screening for IPV, they expressed positive attitudes and beliefs about screening in VHA primary care settings. Themes also included the importance of a comprehensive health care response to IPV, such as interdisciplinary coordination of care and team-based approaches to detection and intervention. Barriers to routine screening were identified, as well as recommendations for training programs and clinical tools to inform the successful implementation of a standardized IPV screening and response program in VHA. Although preliminary, these findings represent an initial step in an essential line of research.
    Full-text · Article · Nov 2013 · Journal of Family Violence
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    • "While the number of publications on gender differences in VA healthcare has increased steadily since 2000 [7] [8] [9] [10], none have accounted for the potential effects of clustering on their estimates. In this case, women Veterans healthcare utilization may in part be a function of military service, and women more likely to serve in specific military branches (e.g. "
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    ABSTRACT: Women currently constitute 15% of active United States of America military service personnel, and this proportion is expected to double in the next 5 years. Previous research has shown that healthcare utilization and costs differ in women US Veterans Health Administration (VA) patients compared to men. However, none have accounted for the potential effects of clustering on their estimates of healthcare utilization. US Women Veterans are more likely to serve in specific military branches (e.g. Army), components (e.g. National Guard), and ranks (e.g. officer) than men. These factors may confer different risk and protection that can affect subsequent healthcare needs. Our study investigates the effects of accounting for the hierarchical structure of data on estimates of the association between gender and VA healthcare utilization. The sample consisted of data on 406,406 Veterans obtained from VA's Operation Enduring Freedom/ Operation Iraqi Freedom roster provided by Defense Manpower Data Center — Contingency Tracking System Deployment File. We compared three statistical models, ordinary, fixed and random effects hierarchical logistic regression, in order to assess the association of gender with healthcare utilization, controlling for branch of service, component, rank, age, race, and marital status. Gender was associated with utilization in ordinary logistic and, but not in fixed effects hierarchical logistic or random effects hierarchical logistic regression models. This points out that incomplete inference could be drawn by ignoring the military structure that may influence combat exposure and subsequent healthcare needs. Researchers should consider modeling VA data using methods that account for the potential clustering effect of hierarchy.
    Full-text · Article · Jan 2013
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    • "Because of the rapid influx of Veterans from Operations Enduring Freedom and Iraqi Freedom, many studies of post-deployment health were also funded, including assessments of women's mental health and substance abuse service needs, physical and/or sexual assault of deployed women, gender differences in stigma and barriers to care, and community and family reintegration (including service needs for women Veteran mothers). Further, experts in research development recommended building capacity, fostering collaborations and mentorship; providing the infrastructure and technical consultation to help surmount methodological barriers and limitations, e.g., recruiting sufficient numbers of women Veterans; and increasing the visibility and impact of VA women's health research, e.g., journal supplements (Yano et al., 2006). Attendees also recommended greater oversampling of women Veterans in ongoing data collection efforts, including VA performance measures. "
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    ABSTRACT: The purpose of this paper is to report on the outcomes of the 2010 VA Women's Health Services Research Conference, which brought together investigators interested in pursuing research on women veterans and women in the military with leaders in women's health care delivery and policy within and outside the VA, to significantly advance the state and future direction of VA women's health research and its potential impacts on practice and policy. Building on priorities assembled in the previous VA research agenda (2004) and the research conducted in the intervening six years, we used an array of approaches to foster research-clinical partnerships that integrated the state-of-the-science with the informational and strategic needs of senior policy and practice leaders. With demonstrated leadership commitment and support, broad field-based participation, strong interagency collaboration and a push to accelerate the move from observational to interventional and implementation research, the Conference provided a vital venue for establishing the foundation for a new research agenda. In this paper, we provide the historical evolution of the emergence of women veterans' health services research and an overview of the research in the intervening years since the first VA women's health research agenda. We then present the resulting VA Women's Health Research Agenda priorities and supporting activities designed to transform care for women veterans in six broad areas of study, including access to care and rural health; primary care and prevention; mental health; post deployment health; complex chronic conditions, aging and long-term care; and reproductive health.
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