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Fortier CB, Kenna A, Katz D, Kim S, Hursh C, Beck B, Sablone CA, Currao A, Lebas A, Jorge RE, Fonda JR. STEP-Home transdiagnostic group reintegration workshop to improve mental health outcomes for post-9/11 Veterans: Design, methods, and rationale for a randomized controlled behavioral trial. Contemp Clin Trials 2024; 141:107536. [PMID: 38614448 DOI: 10.1016/j.cct.2024.107536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/17/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Many post-9/11 U.S. combat Veterans experience difficulty readjusting to civilian life after military service, including relationship problems, reduced work productivity, substance misuse, and increased anger control problems. Mental health problems are frequently cited as causing these difficulties, driven by unparalleled rates of mild traumatic brain injury, posttraumatic stress, and other co-occurring emotional and physical conditions. Given the high prevalence of multimorbidity in this cohort, acceptable, non-stigmatizing, transdiagnostic interventions targeting reintegration are needed. The STEP-Home reintegration workshop has the potential to significantly improve skills to foster civilian reintegration, increase engagement in VA services, and improve mental health outcomes in Veterans with and without diagnosed clinical conditions. METHODS/DESIGN Ongoing from 2019, a prospective, two-site, randomized trial of 206 post-9/11 U.S. military Veterans randomized to receive either 12 sessions of the STEP-Home transdiagnostic reintegration workshop (SH; Active Intervention) or Present Centered Reintegration Group Therapy (PCRGT; Active Control Intervention). Primary outcomes are reintegration, anger, and emotional regulation post-intervention and at 3-months post-intervention. Secondary outcomes include measures of mental health, functional and vocational status, and cognition. CONCLUSION This study addresses an important gap in transdiagnostic interventions to improve civilian reintegration in post-9/11 Veterans. STEP-Home is designed to promote treatment engagement and retention, opening the door to critically needed VA care, and ultimately reducing long-term healthcare burden of untreated mental health illness in U.S. Veterans. TRIAL REGISTRATION Clinicaltrials.gov: D2907-R.
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Affiliation(s)
- Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Alexandra Kenna
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Dylan Katz
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Sahra Kim
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Colleen Hursh
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Brigitta Beck
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Caroline A Sablone
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Alyssa Currao
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Adam Lebas
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
| | - Ricardo E Jorge
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Baylor College of Medicine, Houston, TX, United States of America
| | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders National Network Center, VA Boston Healthcare System, Boston, Massachusetts & Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Department of Psychiatry, Boston University Chobanian and Avedisian school of Medicine, Boston, MA, United States of America
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Locke ER, Thomas RM, Simpson TL, Fortney JC, Battaglia C, Trivedi RB, Gylys-Colwell J, Swenson ER, Edelman JD, Fan VS. Cognitive and Emotional Responses to Chronic Obstructive Pulmonary Disease Exacerbations and Patterns of Care Seeking. Ann Am Thorac Soc 2024; 21:559-567. [PMID: 37966313 DOI: 10.1513/annalsats.202303-287oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/15/2023] [Indexed: 11/16/2023] Open
Abstract
Rationale: Cognitive and emotional responses associated with care seeking for chronic obstructive pulmonary disease (COPD) exacerbations are not well understood.Objectives: We sought to define care-seeking profiles based on whether and when U.S. veterans seek care for COPD exacerbations and compare cognitive and emotional responses with exacerbation symptoms across the profiles.Methods: This study analyzes data from a 1-year prospective observational cohort study of individuals with COPD. Cognitive and emotional responses to worsening symptoms were measured with the Response to Symptoms Questionnaire, adapted for COPD. Seeking care was defined as contacting or visiting a healthcare provider or going to the emergency department. Participants were categorized into four care-seeking profiles based on the greatest delay in care seeking for exacerbations when care was sought: 0-3 days (early), 4-7 days (short delay), >7 days (long delay), or never sought care for any exacerbation. The proportion of exacerbations for which participants reported cognitive and emotional responses was estimated for each care-seeking profile, stratified by the timing of when care was sought.Results: There were 1,052 exacerbations among 350 participants with Response to Symptoms Questionnaire responses. Participants were predominantly male (96%), and the mean age was 69.3 ± 7.2 years. For the 409 (39%) exacerbations for which care was sought, the median delay was 3 days. Those who sought care had significantly more severe COPD (forced expiratory volume in 1 s, modified Medical Research Council dyspnea scale) than those who never sought care. Regardless of the degree of delay until seeking care at one exacerbation, participants consistently reported experiencing serious symptoms if they sought care compared with events for which participants did not seek care (e.g., among early care seekers when care was sought, 36%; when care was not sought, 25%). Similar findings were seen in participants' assessment of the importance of getting care (e.g., among early care seekers when care was sought, 90%; when care was not sought, 52%) and their assessment of anxiety about the symptoms (e.g., among early care seekers when care was sought, 33%; when care was not sought, 17%).Conclusions: Delaying or not seeking care for COPD exacerbations was common. Regardless of care-seeking profile, cognitive and emotional responses to symptoms when care was sought differed from responses when care was not sought. Emotional and cognitive response to COPD exacerbations should be considered when developing individualized strategies to encourage seeking care for exacerbations.Clinical trial registered with www.clinicaltrials.gov (NCT02725294).
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Affiliation(s)
- Emily R Locke
- Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Rachel M Thomas
- Center of Innovation for Veteran-Centered and Value-Driven Care
| | - Tracy L Simpson
- Center of Excellence in Substance Addiction Treatment and Education, and
- Department of Psychiatry and Behavioral Sciences and
| | - John C Fortney
- Center of Innovation for Veteran-Centered and Value-Driven Care
- Department of Psychiatry and Behavioral Sciences and
| | - Catherine Battaglia
- Veterans Affairs Eastern Colorado Health Care System, U.S. Department of Veterans Affairs, Aurora, Colorado
- Department of Health Systems, Management & Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ranak B Trivedi
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, U.S. Department of Veterans Affairs, Palo Alto, California; and
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | | | - Erik R Swenson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jeffrey D Edelman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, U.S. Department of Veterans Affairs, Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Vincent S Fan
- Center of Innovation for Veteran-Centered and Value-Driven Care
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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Jervis LL, Kleszynski K, TallBull G, Porter O, Shore J, Bair B, Manson S, Kaufman CE. Rural Native Veterans' Perceptions of Care in the Context of Navigator Program Development. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01955-9. [PMID: 38498116 DOI: 10.1007/s40615-024-01955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION American Indian and Alaska Natives serve in the military at one of the highest rates of all racial and ethnic groups. For Veterans, the already significant healthcare disparities Natives experience are aggravated by barriers to accessing care, care navigation, and coordination of health care within the Veterans Health Administration (VHA) between the VHA and tribal health systems. To mitigate these barriers, the VHA is developing a patient navigation program designed specifically for rural Native Veterans. We describe formative work aimed at understanding and addressing barriers to VHA care from the perspective of rural Native Veterans and those who facilitate their care. METHODS Thirty-four individuals participated in semi-structured interviews (22 Veterans, 6 family members, and 6 Veteran advocates) drawn from 9 tribal communities across the US. RESULTS Participants described many barriers to using the VHA, including perceptions of care scarcity, long travel distances to the VHA, high travel costs, and bureaucratic barriers including poor customer service, scheduling issues, and long waits for appointments. Many Veterans preferred IHS/tribal health care over the VHA due to its proximity, simplicity, ease of use, and quality. CONCLUSION Rural Native Veterans must see a clear benefit to using the VHA given the many obstacles to its use. Veteran recommendations for addressing barriers to VHA care within a navigation program include assistance enrolling in, scheduling, and navigating VHA systems; paperwork assistance; cost reimbursement; and care coordination with the IHS/tribal health care.
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Affiliation(s)
- Lori L Jervis
- Department of Anthropology and Center for Applied Social Research, University of Oklahoma, Norman, OK, USA.
| | - Keith Kleszynski
- Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gloria TallBull
- Center for Applied Social Research, University of Oklahoma, Norman, OK, USA
| | - Olivia Porter
- Department of Anthropology, University of Oklahoma, Norman, OK, USA
| | - Jay Shore
- Veterans Rural Health Resource Center, Salt Lake City, UT, USA
- Centers for American Indian and Alaska Native Health, Colorado School for Public Health, Aurora, CO, USA
| | - Byron Bair
- Veterans Rural Health Resource Center, Salt Lake City, UT, USA
| | - Spero Manson
- Centers for American Indian and Alaska Native Health, Colorado School for Public Health, Aurora, CO, USA
| | - Carol E Kaufman
- Veterans Rural Health Resource Center, Salt Lake City, UT, USA
- Centers for American Indian and Alaska Native Health, Colorado School for Public Health, Aurora, CO, USA
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Smith AH, Touchett H, Chen P, Fletcher T, Arney J, Hogan J, Wassef M, Cloitre M, Lindsay JA. Patient Satisfaction With a Coach-Guided, Technology-Based Mental Health Treatment: Qualitative Interview Study and Theme Analysis. JMIR Ment Health 2024; 11:e50977. [PMID: 38306167 PMCID: PMC10873794 DOI: 10.2196/50977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Technology-based mental health interventions address barriers rural veterans face in accessing care, including provider scarcity and distance from the hospital or clinic. webSTAIR is a 10-module, web-based treatment based on Skills Training in Affective and Interpersonal Regulation, designed to treat posttraumatic stress disorder and depression in individuals exposed to trauma. Previous work has demonstrated that webSTAIR is acceptable to participants and effective at reducing symptoms of posttraumatic stress disorder and depression when delivered synchronously or asynchronously (over 5 or 10 sessions). OBJECTIVE This study explored factors that lead to greater patient satisfaction with webSTAIR, a web-based, coach-guided intervention. METHODS We analyzed qualitative interview data to identify themes related to patient satisfaction with webSTAIR delivered with synchronous video-based coaching. RESULTS Four themes emerged from the data: (1) coaching provides accountability and support, (2) self-pacing offers value that meets individual needs, (3) participants like the comfort and convenience of the web-based format, and (4) technical issues were common but not insurmountable. CONCLUSIONS We conclude that participants valued the accountability, flexibility, and convenience of tech-based interventions with video-delivered coaching.
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Affiliation(s)
- Ashley Helm Smith
- Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, Houston, TX, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | - Hilary Touchett
- Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, Houston, TX, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Patricia Chen
- Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Terri Fletcher
- Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, Houston, TX, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Jennifer Arney
- Department of Sociology, College of Human Sciences and Humanities, University of Houston Clear Lake, Houston, TX, United States
| | - Julianna Hogan
- Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, Houston, TX, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Miryam Wassef
- Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, Houston, TX, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Marylene Cloitre
- National Center for Post-Traumatic Stress Disorder Dissemination and Training Division, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Jan A Lindsay
- Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, Houston, TX, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Rice University's Baker Institute for Public Policy, Houston, TX, United States
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Blonigen DM, Montena AL, Smith J, Hedges J, Kuhn E, Carlson EB, Owen J, Wielgosz J, Possemato K. Peer-supported mobile mental health for veterans in primary care: A pilot study. Psychol Serv 2023; 20:734-744. [PMID: 36107676 PMCID: PMC10278739 DOI: 10.1037/ser0000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
One in four veteran primary care patients suffers from a mental health condition; however, most do not receive any treatment for these problems. Mobile health (mHealth) can overcome barriers to care access, but poor patient engagement limits the effectiveness and implementation of these tools. Peers may facilitate patient engagement with mHealth. We designed a protocol for peers to support implementation of mobile mental health tools in primary care and tested the feasibility, acceptability, and clinical utility of this approach. Thirty-nine patients across two Veterans Affairs sites who screened positive for depression during a primary care visit and were not currently in mental health treatment were enrolled. Participants were scheduled for four phone sessions with a peer over 8 weeks and introduced to five mobile apps for a range of transdiagnostic mental health issues (stress, low mood, sleep problems, anger, and trauma). Pre/post phone interviews using quantitative and qualitative approaches assessed participants' self-reported app use, satisfaction with the intervention, symptom change (stress, anxiety, depression, insomnia), and progress with personal health goals. On average, patients reported using 3.04 apps (SD = 1.46). Per the Client Satisfaction Questionnaire, global satisfaction with the intervention was high (M = 25.71 out of 32, SD = 3.95). Pre to post participants reported significant improvements in their level of stress, based on a quantitative measure (p = .008), and 87% reported progress on at least one personal health goal. Findings support the feasibility, acceptability, and clinical utility of peer-supported mobile mental health for veterans in primary care. A randomized controlled trial of an adaptive version of this intervention is recommended. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Daniel M. Blonigen
- HSR&D Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | - Jennifer Smith
- HSR&D Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System
| | - Jacob Hedges
- VA Center for Integrated Healthcare, Syracuse VA Medical Center
| | - Eric Kuhn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
- National Center for PTSD, Dissemination and Training Division, Department of Veterans Affairs Palo Alto Health Care System
| | - Eve B. Carlson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
- National Center for PTSD, Dissemination and Training Division, Department of Veterans Affairs Palo Alto Health Care System
| | - Jason Owen
- National Center for PTSD, Dissemination and Training Division, Department of Veterans Affairs Palo Alto Health Care System
| | - Joseph Wielgosz
- National Center for PTSD, Dissemination and Training Division, Department of Veterans Affairs Palo Alto Health Care System
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse VA Medical Center
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Hahn Z, Hotchkiss J, Atwood C, Smith C, Totten A, Boudreau E, Folmer R, Chilakamarri P, Whooley M, Sarmiento K. Travel Burden as a Measure of Healthcare Access and the Impact of Telehealth within the Veterans Health Administration. J Gen Intern Med 2023:10.1007/s11606-023-08125-3. [PMID: 37340257 DOI: 10.1007/s11606-023-08125-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/24/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Travel is a major barrier to healthcare access for Veteran Affairs (VA) patients, and disproportionately affects rural Veterans (approximately one quarter of Veterans). The CHOICE/MISSION acts' intent is to increase timeliness of care and decrease travel, although not clearly demonstrated. The impact on outcomes remains unclear. Increased community care increases VA costs and increases care fragmentation. Retaining Veterans within the VA is a high priority, and reduction of travel burdens will help achieve this goal. Sleep medicine is presented as a use case to quantify travel related barriers. OBJECTIVE The Observed and Excess Travel Distances are proposed as two measures of healthcare access, allowing for quantification of healthcare delivery related to travel burden. A telehealth initiative that reduced travel burden is presented. DESIGN Retrospective, observational, utilizing administrative data. SUBJECTS VA patients with sleep related care between 2017 and 2021. In-person encounters: Office visits and polysomnograms; telehealth encounters: virtual visits and home sleep apnea tests (HSAT). MAIN MEASURES Observed distance: distance between Veteran's home and treating VA facility. Excess distance: difference between where Veteran received care and nearest VA facility offering the service of interest. Avoided distance: distance between Veteran's home and nearest VA facility offering in-person equivalent of telehealth service. KEY RESULTS In-person encounters peaked between 2018 and 2019, and have down trended since, while telehealth encounters have increased. During the 5-year period, Veterans traveled an excess 14.1 million miles, while 10.9 million miles of travel were avoided due to telehealth encounters, and 48.4 million miles were avoided due to HSAT devices. CONCLUSIONS Veterans often experience a substantial travel burden when seeking medical care. Observed and excess travel distances are valuable measures to quantify this major healthcare access barrier. These measures allow for assessment of novel healthcare approaches to improve Veteran healthcare access and identify specific regions that may benefit from additional resources.
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Affiliation(s)
- Zachary Hahn
- Togus VA Medical Center, 1 VA Ctr, Augusta, ME, 04330, USA.
| | | | | | - Connor Smith
- Portland VA Medical Center, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | | | - Eilis Boudreau
- Portland VA Medical Center, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - Robert Folmer
- Portland VA Medical Center, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | | | - Mary Whooley
- San Francisco VA Medical Center, San Francisco, CA, USA
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Stryczek KC, Honsberger M, Ball SL, Barnard JG, Young JP, Felker B, Au DH, Ho PM, Kirsh SR, Sayre GG. VA Outreach Is an Essential Area for Improving Veterans' Health Care Accessibility. Mil Med 2023; 188:usad019. [PMID: 36790439 DOI: 10.1093/milmed/usad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/05/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION The Veterans Health Administration (VHA) is tasked with providing access to health care to veterans of military service. However, many eligible veterans have either not yet enrolled or underutilized VHA services. Further study of barriers to access before veterans enroll in VHA care is necessary to understand how to address this issue. The ChooseVA (née MyVA Access) initiative aims to achieve this mission to improve veterans' health care access. Although veteran outreach was not specifically addressed by the initiative, it is a critical component of improving veterans' access to health care. Findings from this multisite evaluation of ChooseVA implementation describe sites' efforts to improve VHA outreach and veterans' experiences with access. MATERIALS AND METHODS This quality improvement evaluation employed a multi-method qualitative methodology, including 127 semi-structured interviews and 81 focus groups with VHA providers and staff ("VHA staff") completed during 21 VHA medical center facility site visits between July and November 2017 and 48 telephone interviews with veterans completed between May and October 2018. Interviews and focus groups were transcribed and analyzed using deductive and inductive analysis to capture challenges and strategies to improve VHA health care access (VHA staff data), experiences with access to care (veteran data), barriers and facilitators to care (staff and veteran data), contextual factors, and emerging categories and themes. We developed focused themes describing perceived challenges, descriptions of VHA staff efforts to improve veteran outreach, and veterans' experiences with accessing VHA health care. RESULTS VHA staff and veteran respondents reported a lack of veteran awareness of eligibility for VHA services. Veterans reported limited understanding of the range of services offered. This awareness gap served as a barrier to veterans' ability to successfully access VHA health care services. Veterans described this awareness gap as contributing to delayed VHA enrollment and delayed or underutilized health care benefits and services. Staff focused on community outreach and engaging veterans for VHA enrollment as part of their efforts to implement the ChooseVA access initiative. Staff and veteran respondents agreed that outreach efforts were helpful for engaging veterans and facilitating access. CONCLUSIONS Although efforts across VHA programs informed veterans about VHA services, our results suggest that both VHA staff and veterans agreed that missed opportunities exist. Gaps include veterans' lack of awareness or understanding of VHA benefits for which they qualify for. This can result in delayed access to care which may negatively impact veterans, including those separating from the military and vulnerable populations such as veterans who experience pregnancy or homelessness.
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Affiliation(s)
- Krysttel C Stryczek
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Mark Honsberger
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Sherry L Ball
- VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA
| | - Juliana G Barnard
- VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jessica P Young
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
| | - Bradford Felker
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA
| | - David H Au
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195-6522, USA
| | - P Michael Ho
- VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Susan R Kirsh
- The U.S. Department of Veterans Affairs Central Office, Washington, DC 20420, USA
| | - George G Sayre
- VA Puget Sound Health Care System, Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA 98108, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA 98195, USA
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Ulmer CS, Bosworth HB, Zervakis J, Goodwin K, Gentry P, Rose C, Jeffreys AS, Olsen MK, Weidenbacher HJ, Beckham JC, Voils CI. Provider-supported self-management cognitive behavioral therapy for insomnia (Tele-Self CBTi): Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 125:107060. [PMID: 36567058 DOI: 10.1016/j.cct.2022.107060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cognitive Behavioral Therapy for Insomnia (CBTi) is recommended as first-line treatment for insomnia, yet patient access to CBTi is limited. Self-help CBTi could increase patient access. Self-help CBTI with provider sup]port is more effective and is preferred by patients. Self-help CBTi has not been evaluated in veterans; a population with greater medical and mental health morbidity and more severe sleep difficulties than non-veterans. Moreover, those with mental health conditions have been largely excluded from prior CBTi self-help trials. Stablishing the efficacy of provider-supported Self-help CBTi is an important first step for expanding veteran access to CBTi. METHODS In a 2-armed randomized controlled trial, a provider-supported self-help CBTi (Tele-Self CBTi) is compared to Health Education for improving insomnia severity (primary outcome) among treatment-seeking veterans with insomnia disorder. Tele-Self CBTi is comprised of two treatment components: self-help CBTi via a professionally designed manual developed using an iterative process of expert review and patient input; and 6 telephone-based support sessions lasting >20 min. Outcomes are assessed at baseline, 8 weeks, and 6 months after baseline. The primary outcome, insomnia severity, is measured using the Insomnia Severity Index. Secondary outcomes include self-reported and actigraphy-assessed sleep, fatigue, depression symptoms, and sleep-related quality of life. CONCLUSION Innovative approaches are essential to improving overall health among veterans; a population with highly prevalent insomnia disorder. If effective, Tele-Self CBTi may bridge the gap between unavailable resources and high demand for CBTi and serve as the entry level intervention in a stepped model of care. CLINICAL TRIALS GOV IDENTIFIER NCT03727438.
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Affiliation(s)
- Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, 411 West Chapel Hill Street, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America.
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, 411 West Chapel Hill Street, Durham, NC, United States of America; Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Jennifer Zervakis
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, 411 West Chapel Hill Street, Durham, NC, United States of America
| | - Kaitlyn Goodwin
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, 411 West Chapel Hill Street, Durham, NC, United States of America
| | - Pamela Gentry
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Cynthia Rose
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, 411 West Chapel Hill Street, Durham, NC, United States of America
| | - Maren K Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, 411 West Chapel Hill Street, Durham, NC, United States of America; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States of America
| | - Hollis J Weidenbacher
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs, 411 West Chapel Hill Street, Durham, NC, United States of America
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America; VISN 6 Mental Illness Research, Education, and Clinical Center, Veterans Affairs, Durham, NC, United States of America
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States of America
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9
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Basch C, Ferguson JM, Van Campen J, Slightam C, Jacobs JC, Heyworth L, Zulman D. Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs' Video-Enabled Tablets Before and During the COVID-19 Pandemic. J Med Internet Res 2023; 25:e42563. [PMID: 36630650 PMCID: PMC9912147 DOI: 10.2196/42563] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. OBJECTIVE This study aimed to characterize veterans who received and used US Department of VA-issued video-enabled tablets before versus during the COVID-19 pandemic. METHODS We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. RESULTS There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9% vs 3766/6784, 55.5%), and have a history of housing instability (8633/36,107, 23.9% vs 1022/6784, 15.1%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4% vs 2995/6784, 44.2%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. CONCLUSIONS Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA's tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients.
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Affiliation(s)
| | - Jacqueline M Ferguson
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - James Van Campen
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Cindie Slightam
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Josephine C Jacobs
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth Services, Veterans Health Administration, Washington, DC, United States.,Department of Medicine, University of California San Diego Health System, San Diego, CA, United States
| | - Donna Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, United States.,Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
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10
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Using Veterans Socials to Build a Community: Feasibility of the VOICES Intervention. Community Ment Health J 2022; 58:1544-1553. [PMID: 35524906 PMCID: PMC9077030 DOI: 10.1007/s10597-022-00969-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/26/2022] [Indexed: 01/27/2023]
Abstract
Increasing social connection and access to care has been found to decrease the rate of suicide in U.S. veterans. The Veteran Outreach Into the Community to Expand Social Support (VOICES) is an intervention developed by Department Veteran Affairs (VA) staff to improve social connection and provide information about services by implementing community-based Veterans Socials. Seventy veterans at eight locations completed an anonymous cross-sectional survey. This evaluation examined three domains, acceptability (i.e., perceived value), demand (i.e., estimated or actual use), and expansion (i.e., sustainability and increase of Veterans Socials across time and locations). Findings indicated considerable levels of acceptability, demand for, and expansion of this intervention. Additionally, data suggested this intervention may increase social connection and utilization of VA services among attendees.
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11
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Russell PD, Judkins JL, Blessing A, Moore B, Morissette SB. Incidences of anxiety disorders among active duty service members between 1999 and 2018. J Anxiety Disord 2022; 91:102608. [PMID: 36029531 DOI: 10.1016/j.janxdis.2022.102608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Anxiety disorders can impact the health, performance, and retention of military service members. To inform prevention initiatives and long-term treatment planning, incidence rates across anxiety disorders were evaluated among U.S. active-duty service members over a 20-year period. METHOD Data were extracted from the Defense Medical Epidemiological Database to examine incidence rates of generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia (AG), social anxiety disorder (SAD), obsessive compulsive disorder (OCD), agoraphobia with panic disorder (AWPD), agoraphobia without history of panic disorder (AWOPD), and unspecified anxiety disorder (UAD) among 151,844 service members between 1999 and 2018 in relation to sex, age, race, marital status, military pay grade, service branch. RESULTS Incidence rates of anxiety disorders increased significantly over the 20-year period. Anxiety disorder incidence rates ranged widely from 0.01 to 23.70 (per 1000 service members). There were significant differences in observed versus expected diagnostic rates across all demographic variables examined (p < 0.001). CONCLUSION Incidence rates varied considerably across the anxiety disorders, with UAD being the highest. These data highlight the importance of health care professionals attending to anxiety disorders, in order to plan for service member needs, develop preventative interventions, address early detection, and deliver treatments to improve combat readiness.
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Affiliation(s)
- Patricia D Russell
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | - Jason L Judkins
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave., Natick, MA 01760, USA
| | - Alexis Blessing
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Brian Moore
- Department of Psychological Science, Kennesaw State University, 1000 Chastain Road NW, Kennesaw, GA 30144, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
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12
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Increasing Engagement of Women Veterans in Health Research. J Gen Intern Med 2022; 37:42-49. [PMID: 35349014 PMCID: PMC8993961 DOI: 10.1007/s11606-021-07126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Meaningful engagement of patients in health research has the potential to increase research impact and foster patient trust in healthcare. For the past decade, the Veterans Health Administration (VA) has invested in increasing Veteran engagement in research. OBJECTIVE We sought the perspectives of women Veterans, VA women's health primary care providers (WH-PCPs), and administrators on barriers to and facilitators of health research engagement among women Veterans, the fastest growing subgroup of VA users. DESIGN Semi-structured qualitative telephone interviews were conducted from October 2016 to April 2018. PARTICIPANTS Women Veterans (N=31), WH-PCPs (N=22), and administrators (N=6) were enrolled across five VA Women's Health Practice-Based Research Network sites. APPROACH Interviews were audio-recorded and transcribed. Consensus-based coding was conducted by two expert analysts. KEY RESULTS All participants endorsed the importance of increasing patient engagement in women's health research. Women Veterans expressed altruistic motives as a personal determinant for research engagement, and interest in driving women's health research forward as a stakeholder or research partner. Challenges to engagement included lack of awareness about opportunities, distrust of research, competing priorities, and confidentiality concerns. Suggestions to increase engagement include utilizing VA's patient-facing portals of the electronic health record for outreach, facilitating "warm hand-offs" between researchers and clinic staff, developing an accessible research registry, and communicating the potential research impact for Veterans. CONCLUSIONS Participants expressed support for increasing women Veterans' engagement in women's health research and identified feasible ways to foster and implement engagement of women Veterans. Given the unique healthcare needs of women Veterans, engaging them in research could translate to improved care, especially for future generations. Knowledge about how to improve women Veterans' research engagement can inform future VA policy and practice for more meaningful interventions and infrastructure.
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13
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Sullivan-Baca E, Babicz MA, Choudhury TK, Miller BI. The Relationship between Health Literacy and Comfort with Teleneuropsychology in a Veteran Sample. Arch Clin Neuropsychol 2022; 37:292-301. [PMID: 34599332 PMCID: PMC8500040 DOI: 10.1093/arclin/acab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Health literacy is a strong psychosocial determinant of health disparities and has been found to relate to various aspects of health-related technology use. With the increased implementation of neuropsychological services performed via telehealth during the coronavirus disease 2019 pandemic, the relationship between health literacy and comfort with teleneuropsychology warrants further investigation. METHOD The present study examined 77 Veterans participating in neuropsychological evaluations as a part of standard clinical care. The sample was diverse in terms of age ethnicity, and psychiatric and neurocognitive diagnoses. In addition to a fixed-flexible neuropsychological battery, the Brief Health Literacy Screening Tool (BRIEF) was administered to evaluate health literacy. Self-reported comfort with the teleneuropsychological evaluation was assessed using an informal 10-point scale, and qualitative comfort responses were also recorded. RESULTS Independent samples t-tests revealed older adults were more likely to participate in the evaluation via telephone than with VA Video Connect. Although health literacy was not related to telehealth modality, it was correlated with comfort with the teleneuropsychological evaluation (r = .34, p < .01), although it is notable that average comfort levels were high across modalities (M = 8.16, SD = 2.50). CONCLUSIONS Findings support the notion that teleneuropsychological services may feasibly be implemented with a diverse group of patients, although flexibility with modality may be necessary. Those performing these services should also be aware that patients with lower health literacy may feel less comfortable with teleneuropsychology as they seek to build rapport and optimize evaluation engagement.
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Affiliation(s)
- Erin Sullivan-Baca
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michelle A Babicz
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tabina K Choudhury
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Brian I Miller
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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14
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Ghosh A, Niileksela CR, Grzesik ER. Measurement Invariance of the Occupational Engagement Scale – Student and Career Adapt-Abilities Scale across Veterans and Civilians. JOURNAL OF CAREER ASSESSMENT 2022. [DOI: 10.1177/10690727211059735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Veterans of the U.S. military experience unique difficulties when reentering the civilian workforce, which may inform their post-military career development in different ways than civilians. The purpose of this study was to examine the measurement invariance of the Occupational Engagement Scale-Student (OES-S) and the Career Adapt-Abilities Scale-USA Form (CAAS) across adults with and without a military background. A sample of 418 U.S. military veterans and 411 civilians were recruited. Multiple group confirmatory factor analysis (MG-CFA) was used to examine factorial invariance of scores obtained from the OES-S and CAAS with veterans and civilians. Findings suggested the measures were invariant across veteran and civilian samples. These scales appear to measure the same constructs for veterans and civilians and can likely be used for veterans in both research and practice. Implications for career assessment and counseling are discussed.
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Affiliation(s)
- Arpita Ghosh
- Department of Educational Psychology, The University of Kansas, Lawrence, KS, USA
| | | | - Elizabeth R. Grzesik
- Department of Educational Psychology, The University of Kansas, Lawrence, KS, USA
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15
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Smith J, Aboumrad M, Reyes C, Satram S, Young-Xu Y. Predictors of Incident Severe Acute Respiratory Syndrome Coronavirus 2 Positivity in a Veteran Population. Mil Med 2021; 188:e1268-e1275. [PMID: 34668962 DOI: 10.1093/milmed/usab428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/30/2021] [Accepted: 10/06/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We explored factors related to testing positive for severe acute respiratory coronavirus 2 (SARS-CoV-2) to identify populations most at risk for this airborne pathogen. METHODS Data were abstracted from the medical record database of the U.S. Department of Veterans Affairs and from public sources. Veterans testing positive were matched in a 1:4 ratio to those at a similar timepoint and local disease burden who remained negative between March 1, 2020, and December 31, 2020. Multivariable logistic regression was used to calculate odds ratios for the association of each potential risk factor with a positive test result. RESULTS A total of 24,843 veterans who tested positive for SARS-CoV-2 were matched with 99,324 controls. Cases and controls were similar in age, sex, ethnicity, and rurality, but cases were more likely to be Black, reside in low-income counties, and suffer from dementia. Multivariable analysis demonstrated highest risk for Black veterans, those with dementia or diabetes, and those living in nursing homes or high-poverty areas. Veterans living in counties likely to be more adherent to public health guidelines were at the lowest risk. CONCLUSIONS Our results are similar to those from studies of other populations and add to that work by accounting for several important proxies for risk. In particular, this work has implications for the value of infection control measures at the population level in helping to stem widespread outbreaks of this type.
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Affiliation(s)
- Jeremy Smith
- US Department of Veterans Affairs, Clinical Epidemiology Program, White River Jct, VT 05009, USA
| | - Maya Aboumrad
- US Department of Veterans Affairs, Clinical Epidemiology Program, White River Jct, VT 05009, USA
| | - Carolina Reyes
- Division of Health Economics and Outcomes Research, VIR Biotechnology, San Francisco, CA 94158, USA
| | - Sacha Satram
- Division of Health Economics and Outcomes Research, VIR Biotechnology, San Francisco, CA 94158, USA
| | - Yinong Young-Xu
- US Department of Veterans Affairs, Clinical Epidemiology Program, White River Jct, VT 05009, USA
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16
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Fletcher TL, Amspoker AB, Wassef M, Hogan JB, Helm A, Jackson C, Jacobs A, Shammet R, Speicher S, Lindsay JA, Cloitre M. Increasing access to care for trauma-exposed rural veterans: A mixed methods outcome evaluation of a web-based skills training program with telehealth-delivered coaching. J Rural Health 2021; 38:740-747. [PMID: 34648188 DOI: 10.1111/jrh.12628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE While rural veterans with trauma exposure report high rates of posttraumatic stress disorder (PTSD), depression, and functional impairment, utilization of health services is low. This pilot study used mixed qualitative and quantitative methods to evaluate the potential benefits of a transdiagnostic web-based skills training program paired with telehealth-delivered coaching to address a range of symptoms and functional difficulties. The study directed substantial outreach efforts to women veterans who had experienced military sexual trauma given their growing representation in the Veterans Healthcare Administration (VHA) and identified need for services. METHODS Participants were 32 trauma-exposed veterans enrolled in rural-serving VHA facilities who screened positive for either PTSD or depression. Symptoms of PTSD, depression, emotion regulation, and interpersonal problems were assessed at baseline, midpoint, posttreatment, and 3-month follow-up. Veterans completed exit interviews to identify benefits and limitations of the program. RESULTS Intent-to-treat analyses revealed significant symptom reduction for all outcomes, with large to moderate effect sizes at 3-month follow-up. Outcomes did not differ by gender or military sexual trauma status. Veterans' rating of the therapeutic alliance was high and interview responses indicated that the presence of the coach was critical to success in the program. CONCLUSION This remotely delivered transdiagnostic intervention provided significant benefits across a range of symptoms and functional outcomes and was viewed positively by veterans. The results indicate that further research (ie, a randomized controlled trial) is warranted. Attention to the role of the coach as a means by which to increase engagement and retention in technology-delivered interventions is warranted.
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Affiliation(s)
- Terri L Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Amber B Amspoker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA.,Baylor College of Medicine, Department of Medicine, Houston, Texas, USA
| | - Miryam Wassef
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Julianna B Hogan
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Ashley Helm
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | | | - Adam Jacobs
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Rayan Shammet
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Sarah Speicher
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jan A Lindsay
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA.,Baylor College of Medicine, Department of Medicine, Houston, Texas, USA
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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17
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Sokol Y, Gromatsky M, Edwards ER, Greene AL, Geraci JC, Harris RE, Goodman M. The deadly gap: Understanding suicide among veterans transitioning out of the military. Psychiatry Res 2021; 300:113875. [PMID: 33901974 DOI: 10.1016/j.psychres.2021.113875] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
In the period following separation from the military, service members face the challenge of transitioning to a post-military civilian life. Some evidence suggests these transitioning Veterans are at higher risk for suicide compared with both the broader Veteran population and the United States public, yet they often do not receive adequate support and resources. In this review, we use the Three-Step Theory of suicide to outline characteristics of transitioning Veterans and the transition process that may affect suicide risk. We then highlight relevant services available to this specific subgroup of Veterans and make recommendations that address barriers to care. Cumulatively, this literature suggests transitioning Veterans fall within a "deadly gap" between the end of their military service and transition into civilian life. This "deadly gap" consists of limited psychiatric services and increased suicide risk factors which together may explain the increase in suicide during this transition period.
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Affiliation(s)
- Yosef Sokol
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States.
| | - Molly Gromatsky
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Emily R Edwards
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Ashley L Greene
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
| | - Joseph C Geraci
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Resilience Center for Veterans & Families, Teachers College, Columbia University, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States; Columbia University, United States; Syracuse University, Institute for Veterans and Military Families, United States
| | - Rachel E Harris
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; William Paterson University, United States
| | - Marianne Goodman
- Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), United States; VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, United States; Icahn School of Medicine at Mt. Sinai Hospital, United States
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18
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Davis ML, Neelon B, Nietert PJ, Burgette LF, Hunt KJ, Lawson AB, Egede LE. Propensity score matching for multilevel spatial data: accounting for geographic confounding in health disparity studies. Int J Health Geogr 2021; 20:10. [PMID: 33639940 PMCID: PMC7913404 DOI: 10.1186/s12942-021-00265-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diabetes is a public health burden that disproportionately affects military veterans and racial minorities. Studies of racial disparities are inherently observational, and thus may require the use of methods such as Propensity Score Analysis (PSA). While traditional PSA accounts for patient-level factors, this may not be sufficient when patients are clustered at the geographic level and thus important confounders, whether observed or unobserved, vary by geographic location. METHODS We employ a spatial propensity score matching method to account for "geographic confounding", which occurs when the confounding factors, whether observed or unobserved, vary by geographic region. We augment the propensity score and outcome models with spatial random effects, which are assigned scaled Besag-York-Mollié priors to address spatial clustering and improve inferences by borrowing information across neighboring geographic regions. We apply this approach to a study exploring racial disparities in diabetes specialty care between non-Hispanic black and non-Hispanic white veterans. We construct multiple global estimates of the risk difference in diabetes care: a crude unadjusted estimate, an estimate based solely on patient-level matching, and an estimate that incorporates both patient and spatial information. RESULTS In simulation we show that in the presence of an unmeasured geographic confounder, ignoring spatial heterogeneity results in increased relative bias and mean squared error, whereas incorporating spatial random effects improves inferences. In our study of racial disparities in diabetes specialty care, the crude unadjusted estimate suggests that specialty care is more prevalent among non-Hispanic blacks, while patient-level matching indicates that it is less prevalent. Hierarchical spatial matching supports the latter conclusion, with a further increase in the magnitude of the disparity. CONCLUSIONS These results highlight the importance of accounting for spatial heterogeneity in propensity score analysis, and suggest the need for clinical care and management strategies that are culturally sensitive and racially inclusive.
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Affiliation(s)
- Melanie L. Davis
- Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, Charleston, US
| | - Brian Neelon
- Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, Charleston, US
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | | | - Kelly J. Hunt
- Ralph H. Johnson VA Medical Center, Department of Veterans Affairs, Charleston, US
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, US
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, US
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19
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Veterans Undergoing Total Hip and Knee Arthroplasty: 30-day Outcomes as Compared to the General Population. J Am Acad Orthop Surg 2020; 28:923-929. [PMID: 32004175 DOI: 10.5435/jaaos-d-19-00775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The Veterans Affairs (VA) health system is vital to providing joint replacement care to our retired service members but has come under recent scrutiny. The purpose of this study was to compare the short-term outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA) between the VA cohort and the general cohort. METHODS We retrospectively reviewed 10.460 patients with primary THA and TKA from the Veterans Affairs Corporate Data Warehouse. As a control group, we queried the American College of Surgeons-National Surgical Quality Improvement Program database and identified 58,820 patients with primary THA and TKA over the same time period. We compared length of stay, mortality rates, 30-day complication rates, and 30-day readmissions. We performed a multivariate logistic regression analysis to identify the independent effect of the VA system on adverse outcomes. RESULTS Veterans are more likely to be men (93% versus 41%, P < 0.001) and have increased rates of medical comorbidities (all P < 0.001). The rate of short-term complications (all P < 0.001) were all higher in the VA cohort. When controlling for demographics and medical comorbidities, VA patients were more likely to have a readmission (P < 0.001), prolonged length of stay > 4 days (P < 0.001), and experience a complication within 30 days (P < 0.001). DISCUSSION Despite controlling for higher rates of medical comorbidities, VA patients undergoing primary THA and TKA had poorer short-term outcomes than the civilian cohort. Additional research is needed to ensure our veteran cohort is appropriately optimized and address the discrepancy with the outcomes of the civilian.
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U.S. Military Veterans' Health and Well-Being in the First Year After Service. Am J Prev Med 2020; 58:352-360. [PMID: 31902684 DOI: 10.1016/j.amepre.2019.10.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study examined the health and well-being of U.S. veterans during the first year after military service and tested several hypotheses regarding differences in veterans' well-being over time, across life domains, and based on sex, military rank, and deployment history. METHODS A national sample of 9,566 veterans was recruited from a roster of all separating U.S. service members in the fall of 2016. Veterans' status, functioning, and satisfaction with regard to their health, work, and social relationships were assessed within 3 months of separation and then 6 months later. Analyses were completed in 2019. RESULTS Health concerns were most salient for newly separated veterans, with many veterans reporting that they had chronic physical (53%) or mental (33%) health conditions and were less satisfied with their health than either their work or social relationships. By contrast, most veterans reported relatively high vocational and social well-being and only work functioning demonstrated a notable decline in the first year following separation. Enlisted personnel reported consistently poorer health, vocational, and social outcomes compared with their officer counterparts, whereas war zone-deployed veterans reported more health concerns and women endorsed more mental health concerns compared with their nondeployed and male peers. CONCLUSIONS Although most newly separated veterans experience high vocational and social well-being as they reintegrate into civilian life, findings point to the need for additional attention to the health of separating service members and bolstered support for enlisted personnel to prevent the development of chronic readjustment challenges within this population.
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Barr N, Kintzle S. Can Mindfulness Help to Predict Veterans' Mental Health Service Utilization? SOCIAL WORK 2019; 64:329-338. [PMID: 31560776 DOI: 10.1093/sw/swz026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/20/2019] [Accepted: 05/20/2019] [Indexed: 06/10/2023]
Abstract
Post-9/11 era military veterans are at high risk for posttraumatic stress disorder (PTSD) and depression, but less than half of veterans who screen positive for these disorders seek mental health treatment. Self-stigma of mental illness has emerged as a core barrier to mental health service use (MHSU) in this population. Mindfulness is associated with attention control, nonjudgment, and reduced self-stigma in civilians, but associations between PTSD and depression, mindfulness, self-stigma, and MHSU have never been investigated in military veterans. The present study used a logistic regression modeling strategy to investigate main and interaction effects for PTSD, depression, mindfulness, and self-stigma on MHSU. Study findings demonstrated a positive main effect for PTSD and negative main effects for mindfulness and self-stigma on MHSU, and a positive interaction effect for mindfulness and PTSD on MHSU. Findings suggest that more mindful individuals with PTSD symptoms are more likely to seek mental health services, whereas less mindful individuals with PTSD symptoms are less likely to seek treatment. More research into the potential for mindfulness to enhance MHSU outcomes for military veterans appears warranted.
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A Latent Content Analysis of Barriers and Supports to Healthcare: Perspectives From Caregivers of Service Members and Veterans With Military-Related Traumatic Brain Injury. J Head Trauma Rehabil 2019; 33:342-353. [PMID: 29385014 DOI: 10.1097/htr.0000000000000373] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify barriers and supports that caregivers of individuals with military-related traumatic brain injury (TBI) encounter when navigating the military healthcare system; this information will be used as the foundation of a new patient-reported outcome measure. SETTING Community. PARTICIPANTS Forty-five caregivers of service members and veterans (SMV) who sustained a medically documented mild, moderate, severe, or penetrating TBI. DESIGN Latent content analysis. MAIN MEASURES Nine focus group discussions of barriers and supports to navigating the military healthcare system and community resources. RESULTS Latent content analysis indicated that caregivers discussed barriers (66%) and supports (34%) to obtaining care within the military healthcare system and the community. Caregivers most frequently discussed SMVs' interactions with healthcare, their own interactions with healthcare, family care, and community organizations. CONCLUSIONS Caregivers confront numerous challenges while pursuing healthcare services. Although much of the discussion focused on barriers and perceived unmet needs within the military healthcare system, caregivers also recognized supports within the military healthcare system and general community. Increased attention to accessibility and quality of services, as well as reducing financial burden, can lead to improved health-related quality of life for caregivers and their SMVs.
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Shayman CS, Ha YM, Raz Y, Hullar TE. Geographic Disparities in US Veterans' Access to Cochlear Implant Care Within the Veterans Health Administration System. JAMA Otolaryngol Head Neck Surg 2019; 145:889-896. [PMID: 31369048 DOI: 10.1001/jamaoto.2019.1918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Veterans are at high risk for developing sensorineural hearing loss leading to cochlear implant (CI) candidacy; however, the ability to care for these patients is limited by the number and location of Veterans Health Administration (VHA) facilities that provide specialized CI services. Objective To investigate geographic disparities in access to CI care within the VHA system for US veterans. Design, Setting, and Participants An analysis of census tract-level data including US veterans was conducted using the nationwide American Community Survey data collected by the US Census Bureau from January to December 2016, which were accessed in 2017. Main Outcomes and Measures Maps showing the geographic variability in need for specialized CI services, estimated as a function of the number of veterans and the distance to the nearest established VHA-based CI surgical or audiologic facilities. Results A total of 19.9 million veterans within the continental United States resided at a median distance of 80 miles (interquartile range [IQR], 30.1-140.9 miles; mean [SD], 1002 [465.8] miles) from the nearest VHA facility offering CI care; of these, 3.98 million (20.0%) resided more than 160.7 miles from the nearest VHA facility. When considering only comprehensive facilities offering both surgical and audiologic care, the median distance was 101.3 miles (IQR, 39.4-178.7 miles; mean [SD], 126.0 [448.4] miles), but 20.0% of veterans had to travel more than 201.0 miles to a VHA facility. Veterans residing in urban areas (74.0%) lived a median distance of 61.2 miles (IQR, 23.7-121.3 miles; mean [SD], 83.8 [477.1] miles) from the nearest VHA facility, with 2.9 million (20.0%) living the farthest at 140.7 miles. Veterans residing in rural areas (26.0%) lived a median distance of 119.8 miles (IQR, 79.0-182.4 miles; mean [SD], 146.9 [431.0] miles) from their nearest VHA facility, with 1.04 million (20.0%) living more than 206.2 miles from the nearest VHA facility. Conclusions and Relevance This study's findings suggest that large disparities exist in the distance to the nearest VHA-based CI facilities. Veterans face considerable geographic barriers to obtaining VHA-based CI care in many parts of the country, including some large metropolitan areas. Those requiring only audiologic services face similar geographic barriers as those requiring surgery. Thoughtful placement of new facilities, along with upcoming advances in remote programming of implants, may help ensure appropriate care for this high-risk population.
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Affiliation(s)
- Corey S Shayman
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Yi-Min Ha
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Yael Raz
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland.,Operative Care Division, Veterans Health Administration Portland Health Care System, Portland, Oregon
| | - Timothy E Hullar
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland.,Operative Care Division, Veterans Health Administration Portland Health Care System, Portland, Oregon.,Department of Neurology, Oregon Health & Science University, Portland
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Goetter EM, Blackburn AM, Bui E, Laifer LM, Simon N. Veterans' Prospective Attitudes About Mental Health Treatment Using Telehealth. J Psychosoc Nurs Ment Health Serv 2019; 57:38-43. [DOI: 10.3928/02793695-20190531-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
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Zulman DM, Wong EP, Slightam C, Gregory A, Jacobs JC, Kimerling R, Blonigen DM, Peters J, Heyworth L. Making connections: nationwide implementation of video telehealth tablets to address access barriers in veterans. JAMIA Open 2019; 2:323-329. [PMID: 32766533 DOI: 10.1093/jamiaopen/ooz024] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/22/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Video telehealth technology has the potential to enhance access for patients with clinical, social, and geographic barriers to care. We evaluated the implementation of a US Department of Veterans Affairs (VA) initiative to distribute tablets to high-need Veterans with access barriers. Methods In this mixed methods implementation study, we examined tablet adoption (ie, facility-level tablet distribution rates and patient-level tablet utilization rates) and reach (ie, sociodemographic and clinical characteristics of tablet recipients) between 5/1/16 and 9/30/17. Concurrently, we surveyed 68 facility telehealth coordinators to determine the most common implementation barriers and facilitators, and then conducted interviews with telehealth coordinators and regional leadership to identify strategies that facilitated tablet distribution and use. Results 86 VA facilities spanning all 18 geographic regions, distributed tablets to 6 745 patients. Recipients had an average age of 56 years, 53% lived in rural areas, 75% had a diagnosed mental illness, and they had a mean (SD) of 5 (3) chronic conditions. Approximately 4 in 5 tablet recipients used the tablet during the evaluation period. In multivariate logistic regression, tablet recipients were more likely to use their tablets if they were older and had fewer chronic conditions. Implementation barriers included insufficient training, staffing shortages, and provider disinterest (described as barriers by 59%, 55%, and 33% of respondents, respectively). Site readiness assessments, local champions, licensure modifications, and use of mandates and incentives were identified as strategies that may influence widespread implementation of home-based video telehealth. Conclusion VA's initiative to distribute video telehealth tablets to high-need patients appears to have successfully reached individuals with social and clinical access barriers. Implementation strategies that address staffing constraints and provider engagement may enhance the impact of such efforts.
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Affiliation(s)
- Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Emily P Wong
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Amy Gregory
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | | | - Rachel Kimerling
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA.,VA National Center for Post-Traumatic Stress Disorder, Menlo Park, California, USA
| | - Daniel M Blonigen
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - John Peters
- Office of Connected Care/Telehealth Services, Veterans Health Administration
| | - Leonie Heyworth
- Office of Connected Care/Telehealth Services, Veterans Health Administration.,Department of Medicine, University of California, San Diego
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Veterans' Reliance on VA Care by Type of Service and Distance to VA for Nonelderly VA-Medicaid Dual Enrollees. Med Care 2019; 57:225-229. [PMID: 30676354 DOI: 10.1097/mlr.0000000000001066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Not much is known about nonelderly veterans and their reliance on care from the Veterans Affairs (VA) health care system when they have access to non-VA care. OBJECTIVES To estimate VA reliance for nonelderly veterans enrolled in VA and Medicaid. RESEARCH DESIGN Retrospective, longitudinal analysis of Medicaid claims data and VA administrative data to compare patients' utilization of VA and Medicaid services 12 months before and for up to 12 months after Medicaid enrollment began. SUBJECTS Nonelderly veterans (below 65 y) receiving VA care and newly enrolled in Medicaid, calendar years 2006-2010 (N=19,890). MEASURES VA reliance (proportion of care received in VA) for major categories of outpatient and inpatient care. RESULTS Patients used VA outpatient care at similar levels after enrolling in Medicaid with the exceptions of emergency department (ED) and obstetrics/gynecology care, which decreased. VA inpatient utilization was similar after Medicaid enrollment for most types of care. VA-adjusted outpatient reliance was highest for mental health care (0.99) and lowest for ED care (0.02). VA-adjusted inpatient reliance was highest for respiratory (0.80) and cancer stays (0.80) and lowest for musculoskeletal stays (0.20). Associations between VA reliance and distance to VA providers varied by type of care. CONCLUSIONS Veterans dually enrolled in Medicaid received most of their outpatient care from the VA except ED, obstetrics/gynecology, and dental care. Patients received most of their inpatient care from Medicaid except mental health, respiratory, and cancer care. Sensitivity to travel distance to VA providers explained some of these differences.
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Baria AM, Pangarkar S, Abrams G, Miaskowski C. Adaption of the Biopsychosocial Model of Chronic Noncancer Pain in Veterans. PAIN MEDICINE 2019; 20:14-27. [PMID: 29727005 DOI: 10.1093/pm/pny058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Population Veterans with chronic noncancer pain (CNCP) are a vulnerable population whose care remains a challenge for clinicians, policy-makers, and researchers. As a result of military experience, veterans are exposed to high rates of musculoskeletal injuries, trauma, psychological stressors (e.g., post-traumatic stress disorder, depression, anxiety, substance abuse), and social factors (e.g., homelessness, social isolation, disability, decreased access to medical care) that contribute to the magnitude and impact of CNCP. In the veteran population, sound theoretical models are needed to understand the specific physiological, psychological, and social factors that influence this unique experience. Objective This paper describes an adaption of Gatchel and colleagues' biopsychosocial model of CNCP to veterans and summarizes research findings that support each component of the revised model. The paper concludes with a discussion of important implications for the use of this revised model in clinical practice and future directions for research. Conclusions The adaption of the biopsychosocial model of CNCP for veterans provides a useful and relevant conceptual framework that can be used to guide future research and improve clinical care in this vulnerable population.
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Affiliation(s)
- Ariel M Baria
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,School of Nursing
| | - Sanjog Pangarkar
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, San Francisco, California
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Wu L, Wang G, Birore CMS. Disabilities Status, Health Insurance, and Medical Hardship among Veterans. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:497-509. [PMID: 30497341 DOI: 10.1080/19371918.2018.1546253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aims to examine the health care hardships among veterans and the effects from the measures of disability statuses and health insurance coverage. Patterns and variations for different subgroups are categorized and analyzed. Using the 2014 National Health Interview Survey (NHIS), this study included 2,686 veterans who were active duty in U.S. military in Persian Gulf War in the 1990s and Gulf War-era II since September 2001 or later. The dependent variable, medical hardship, was measured with four dichotomous indicators: problems paying medical bills, currently having medical bills that were being paid over time, currently having medical bills that were unable to be paid at all, and having medical care delayed due to cost. The independent variables were disability status and health care coverage. Covariates included demographics (age, gender, race), socioeconomic status (education, poverty status), along with marital status and self-reported health status. Logistic regressions were employed to predict the likelihood of experiencing health care hardships. Statistical results indicated that health disparities were prevalent in terms of health care hardships. Disabled veterans were more likely to report medical hardships compared to their counterparts with no disability. Having no health insurance coverage further deteriorated the severity of medical hardship. Veterans who self-reported poor health lived in poverty were less educated, and had higher likelihood of experiencing health care hardship. The policy implications can be lined with disabled veterans' programs in terms of outreach activities, community services, and integrated care.
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Affiliation(s)
- Liyun Wu
- a The Ethelyn R. Strong School of Social Work , Norfolk State University , Norfolk , VA
| | - Gang Wang
- b Department of Political Science , University of Zürich , Zürich , Switzerland
| | - Charles M S Birore
- a The Ethelyn R. Strong School of Social Work , Norfolk State University , Norfolk , VA
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Derefinko KJ, Hallsell TA, Isaacs MB, Colvin LW, Salgado Garcia FI, Bursac Z. Perceived Needs of Veterans Transitioning from the Military to Civilian Life. J Behav Health Serv Res 2018; 46:384-398. [DOI: 10.1007/s11414-018-9633-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Huntzinger M, Bielefeldt K. Expanding the Scope of Telemedicine in Gastroenterology. Fed Pract 2018; 35:26-31. [PMID: 30766378 PMCID: PMC6263446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A specialty outreach program relied on telemedicine to reach patients with gastrointestinal and liver diseases in a large service area.
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Affiliation(s)
- Michelle Huntzinger
- is a Nurse and Case Manager and is the Chief of the gastroenterology section at George E. Wahlen VAMC in Salt Lake City, Utah
| | - Klaus Bielefeldt
- is a Nurse and Case Manager and is the Chief of the gastroenterology section at George E. Wahlen VAMC in Salt Lake City, Utah
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Marcus P, Hautala K, Allaudeen N. An Initiative to Change Inpatient Practice: Leveraging the Patient Medical Home for Postdischarge Follow-Up. Jt Comm J Qual Patient Saf 2018; 44:101-106. [PMID: 29389458 DOI: 10.1016/j.jcjq.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 07/08/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The standard of care for hospital discharge planning includes arranging follow-up appointments, usually with a primary care provider. However, follow-up phone calls instead of face-to-face visits may be an appropriate alternative for some patients. This option was explored within the framework of the US Department of Veterans Affairs (VA) patient-centered medical home model of care, the Patient Aligned Care Team. METHODS At a VA hospital, a pilot study was conducted on the use of phone calls from members of a patient's medical home as posthospital discharge follow-up rather than the traditional face-to-face provider model. Inpatient providers were educated about the phone follow-up alternative, and this option was standardized as part of discharge planning rounds. RESULTS During Phase 1 at one clinic over three months, 17 of 118 eligible patients received phone call follow-up (14.4% of discharges) instead of traditional face-to-face follow-up. During Phase 2, data from Phase 1 were analyzed, and staff at the other eight clinic sites were trained. After the expansion of the initiative to all regional clinic sites in Phase 3, 76 of 447 eligible discharges (17.0%) were scheduled for phone follow-up. As a balancing metric, there were no significant differences in rates of 30-day emergency department (ED) utilization (11.9% and 5.9%, (p = 0.47)) or nonelective rehospitalization (16.8% and 17.6%, (p = 0.93)) between these groups during Phase 1. CONCLUSION This initiative changed provider practices to use phone call follow-up for select patients instead of face-to-face provider visits after hospital discharge, without significantly increasing rates of 30-day ED utilization or rehospitalization.
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Elnitsky CA, Fisher MP, Blevins CL. Military Service Member and Veteran Reintegration: A Conceptual Analysis, Unified Definition, and Key Domains. Front Psychol 2017; 8:369. [PMID: 28352240 PMCID: PMC5348503 DOI: 10.3389/fpsyg.2017.00369] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/27/2017] [Indexed: 11/26/2022] Open
Abstract
Returning military service members and veterans (MSMVs) may experience a variety of stress-related disorders and challenges when reintegrating from the military to the community. Facilitating the reintegration, transition, readjustment and coping, and community integration, of MSMVs is a societal priority. To date, research addressing MSMV reintegration has not identified a comprehensive definition of the term or defined the broader context within which the process of reintegration occurs although both are needed to promote valid and reliable measurement of reintegration and clarify related challenges, processes, and their impact on outcomes. Therefore, this principle-based concept analysis sought to review existing empirical reintegration measurement instruments and identify the problems and needs of MSMV reintegration to provide a unified definition of reintegration to guide future research, clinical practice, and related services. We identified 1,459 articles in the health and social sciences literature, published between 1990 and 2015, by searching multiple electronic databases. Screening of abstracts and full text review based on our inclusion/exclusion criteria, yielded 117 articles for review. Two investigators used constant conceptual comparison to evaluate relevant articles independently. We examined the term reintegration and related terms (i.e., transition, readjustment, community integration) identifying trends in their use over time, analyzed the eight reintegration survey instruments, and synthesized service member and veteran self-reported challenges and needs for reintegration. More reintegration research was published during the last 5 years (n = 373) than in the previous 10 years combined (n = 130). The research suggests coping with life stresses plays an integral role in military service member and veteran post-deployment reintegration. Key domains of reintegration include individual, interpersonal, community organizations, and societal factors that may facilitate or challenge successful reintegration, and results suggest that successful coping with life stressors plays an integral role in post-deployment reintegration. Overall, the literature does not provide a comprehensive representation of reintegration among MSMVs. Although, previous research describes military service member and veteran reintegration challenges, this concept analysis provides a unified definition of the phenomenon and identifies key domains of reintegration that may broaden our understanding and guide reintegration research and practice.
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Affiliation(s)
- Christine A. Elnitsky
- College of Health and Human Services, University of North Carolina at CharlotteCharlotte, NC, USA
| | - Michael P. Fisher
- College of Medicine, The University of CincinnatiCincinnati, OH, USA
| | - Cara L. Blevins
- Health Psychology Program, University of North Carolina at CharlotteCharlotte, NC, USA
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Gorman LA, Sripada RK, Ganoczy D, Walters HM, Bohnert KM, Dalack GW, Valenstein M. Determinants of National Guard Mental Health Service Utilization in VA versus Non-VA Settings. Health Serv Res 2016; 51:1814-37. [PMID: 26840993 PMCID: PMC5034208 DOI: 10.1111/1475-6773.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine associations between need, enabling, and predisposing factors with mental health service use among National Guard soldiers in the first year following a combat deployment to Iraq or Afghanistan. DATA SOURCES/STUDY SETTING Primary data were collected between 2011 and 2013 from 1,426 Guard soldiers representing 36 units. STUDY DESIGN Associations between Guard soldier factors and any mental health service use were assessed using multivariable logistic regression models in a cross-sectional study. Further analysis among service users (N = 405) assessed VA treatment versus treatment in other settings. PRINCIPAL FINDINGS Fifty-six percent of Guard soldiers meeting cutoffs on symptom scales received mental health services with 81 percent of those reporting care from the VA. Mental health service use was associated with need (mental health screens and physical health) and residing in micropolitan communities. Among service users, predisposing factors (middle age range and female gender) and enabling factors (employment, income above $50,000, and private insurance) were associated with greater non-VA services use. CONCLUSION Overall service use was strongly associated with need, whereas sector of use (non-VA vs. VA) was insignificantly associated with need but strongly associated with enabling factors. These findings have implications for the recent extension of veteran health coverage to non-VA providers.
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Affiliation(s)
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Dara Ganoczy
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Heather M Walters
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Kipling M Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Gregory W Dalack
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
| | - Marcia Valenstein
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI
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Abstract
BACKGROUND Veteran access to care is an important policy issue that has not previously been examined with population-based survey data. OBJECTIVES This study compares access to care for nonelderly adult Veterans versus comparable non-Veterans, overall and within subgroups defined by simulated eligibility for health care from the Veterans Health Administration and by insurance status. RESEARCH DESIGN We use household survey data from the Medical Expenditure Panel Survey from 2006 to 2011. We use iterative proportional fitting to standardize (control for) differences in age, sex, income, medical conditions, disability, Census region, and Metropolitan Statistical Area. SUBJECTS Nonelderly Veterans and comparable non-Veterans. MEASURES For medical, dental, and prescription medicine treatments, we use 4 access measures: delaying care, inability to obtain care, perceiving delay as a big problem, and perceiving inability to obtain care as a big problem. We also examine having a usual source of care. RESULTS Frequencies of access barriers are similar for nonelderly Veterans and comparable non-Veterans for dental and prescription medicine treatments. For medical treatment, we find that Veterans eligible for VA health care and Veterans with VA use who are uninsured report fewer access problems than the comparable non-Veteran populations for 2 measures: inability to obtain care and reporting inability to obtain care as a big problem. CONCLUSIONS Our results show that uninsured Veterans, the most policy-relevant group, have better access to care than comparable non-Veterans. Our results highlight the importance of adjusting Veteran and non-Veteran comparisons to account for the higher than average health care needs of Veterans.
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Merkl MA, Tanabe P, Sverha JP, Turner B. A Quality Improvement Initiative for Designing and Implementing a Military Service Screening Tool for a Community Emergency Department. J Emerg Nurs 2016; 42:400-7. [PMID: 27033335 DOI: 10.1016/j.jen.2015.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/19/2015] [Accepted: 11/05/2015] [Indexed: 11/17/2022]
Abstract
PROBLEM Veterans eligible for health care in the Veterans Administration (VA) health system often receive care in community emergency Departments. In line with initiatives from Joining Forces and the American Academy of Nursing, emergency departments have an opportunity to screen for veterans during routine ED visits and provide resource information regarding various VA services. METHODS Our aims were to design and implement a screening process to identify veterans during an ED visit, notify ED providers of veteran status, and develop a Veteran Resource Guide to be distributed at the time of discharge. We embedded the mandatory question, "Have you ever served in the military?" in the electronic medical record (EMR). This question was asked of all patients 18 years and older. RESULTS During an 80-day period, we screened 9364 patients and identified 415 veterans who would not be known to the providers using standard methods. We were able to deliver the Veteran Resource Guide to 77 of the 277 veterans discharged home. IMPLICATIONS FOR PRACTICE The addition of the mandatory question about military service to the EMR during the primary care assessment successfully identified veterans who presented for care in a community emergency department. Future initiatives should include automated processes to ensure that the Veteran Resource Guide is provided and to foster collaboration between community emergency departments and the VA.
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Phillips KM, Clark ME, Gironda RJ, McGarity S, Kerns RW, Elnitsky CA, Andresen EM, Collins RC. Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans. ACTA ACUST UNITED AC 2016; 53:413-32. [PMID: 27532156 DOI: 10.1682/jrrd.2014.05.0126] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/02/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Robert W. Kerns
- Pain Research, Informatics, Multi-morbidities, and Education, Center of Innovation, Department of Veterans Affairs (VA) Connecticut Healthcare System, West Haven, CT; and School of Medicine, Yale University, New Haven, CT
| | - Christine A. Elnitsky
- School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC
| | - Elena M. Andresen
- School of Public Health, Oregon Health and Science University; and Portland State University, Portland, OR
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Libin AV, Scholten J, Schladen MM, Danford E, Shara N, Penk W, Grafman J, Resnik L, Bruner D, Cichon S, Philmon M, Tsai B, Blackman M, Dromerick A. Executive functioning in TBI from rehabilitation to social reintegration: COMPASS (goal,) a randomized controlled trial (grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013-2016). Mil Med Res 2015; 2:32. [PMID: 26664736 PMCID: PMC4675019 DOI: 10.1186/s40779-015-0061-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/30/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function. METHODS/DESIGN The COMPASS(goal) (Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community re-integration psychosocial research in veterans with mild traumatic brain injury. COMPASS(goal) integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASS(goal) will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management (intervention) and supported discharge (control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up. DISCUSSION Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.
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Affiliation(s)
- Alexander V. Libin
- />Mental Health Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Joel Scholten
- />Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
| | - Manon Maitland Schladen
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Ellen Danford
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Nawar Shara
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Walter Penk
- />Texas A&M College of Medicine, 8447 TX-47, Bryan, TX 77807 USA
| | - Jordan Grafman
- />Rehabilitation Institute of Chicago, 345 E Superior St., Chicago, IL 60611 USA
| | - Linda Resnik
- />Research Service, Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908 USA
| | - Dwan Bruner
- />Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
| | - Samantha Cichon
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Miriam Philmon
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
| | - Brenda Tsai
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
| | - Marc Blackman
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Alexander Dromerick
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
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True G, Rigg KK, Butler A. Understanding Barriers to Mental Health Care for Recent War Veterans Through Photovoice. QUALITATIVE HEALTH RESEARCH 2015; 25:1443-1455. [PMID: 25488935 DOI: 10.1177/1049732314562894] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite an urgent need for mental health care among U.S. service members returning from deployments to Iraq and Afghanistan, many veterans do not receive timely or adequate treatment. We used photovoice methods to engage veterans in identifying barriers to utilizing mental health services. Veterans described how key aspects of military culture and identity, highly adaptive during deployment, can deter help-seeking behavior and hinder recovery. Veterans' photographs highlighted how mental health symptoms and self-coping strategies operated as barriers to care. Many veterans' photos and stories revealed how negative health care encounters contributed to avoidance and abandonment of treatment; some veterans described these experiences as re-traumatizing. Visual methods can be a powerful tool for engaging recent war veterans in research. In particular, community-based participatory research approaches, which have rarely been used with veterans, hold great promise for informing effective interventions to improve access and enhance provision of patient-centered care for veterans.
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Affiliation(s)
- Gala True
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Khary K Rigg
- University of South Florida, Tampa, Florida, USA
| | - Anneliese Butler
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Insurance status and health-related quality-of-life disparities after trauma: results from a nationally representative survey in the US. Qual Life Res 2015; 25:987-95. [DOI: 10.1007/s11136-015-1126-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
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Thomas KH, Turner LW, Kaufman EM, Paschal A, Knowlden AP, Birch DA, Leeper JD. Predictors of Depression Diagnoses and Symptoms in Veterans: Results From a National Survey. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/21635781.2015.1085928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Henderson LA, Burns C. Posttraumatic stress disorder in reserve veterans: important reintegration considerations for the occupational health nurse. Workplace Health Saf 2015; 63:27-32. [PMID: 25791408 DOI: 10.1177/2165079914565591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a serious mental health concern for returning U.S. military personnel who have a higher prevalence rate of PTSD than the general population. Among the military population, reserve service members are at increased risk of developing PTSD compared with full-time active duty service members mainly due to difficulty reintegrating into civilian life. Understanding the social risk factors along with the protective effects social support has on PTSD in veterans will provide occupational health professionals the opportunity to support reserve veterans with adjustment into post-deployment life. This literature review examines PTSD in reserve veterans, with a focus on occupational factors, social factors, guideline recommendations, available resources, as well as provides suggestions for occupational health nurses caring for reserve veterans returning to the workplace.
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Affiliation(s)
- Lynn A Henderson
- University of South Florida Sunshine Education and Research Center
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Owen JE, Jaworski BK, Kuhn E, Makin-Byrd KN, Ramsey KM, Hoffman JE. mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and Impact of PTSD Coach. JMIR Ment Health 2015; 2:e7. [PMID: 26543913 PMCID: PMC4607374 DOI: 10.2196/mental.3935] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A majority of Americans (58%) now use smartphones, making it possible for mobile mental health apps to reach large numbers of those who are living with untreated, or under-treated, mental health symptoms. Although early trials suggest positive effects for mobile health (mHealth) interventions, little is known about the potential public health impact of mobile mental health apps. OBJECTIVE The purpose of this study was to characterize reach, use, and impact of "PTSD Coach", a free, broadly disseminated mental health app for managing posttraumatic stress disorder (PTSD) symptoms. METHODS Using a mixed-methods approach, aggregate mobile analytics data from 153,834 downloads of PTSD Coach were analyzed in conjunction with 156 user reviews. RESULTS Over 60% of users engaged with PTSD Coach on multiple occasions (mean=6.3 sessions). User reviews reflected gratitude for the availability of the app and being able to use the app specifically during moments of need. PTSD Coach users reported relatively high levels of trauma symptoms (mean PTSD Checklist Score=57.2, SD=15.7). For users who chose to use a symptom management tool, distress declined significantly for both first-time users (mean=1.6 points, SD=2.6 on the 10-point distress thermometer) and return-visit users (mean=2.0, SD=2.3). Analysis of app session data identified common points of attrition, with only 80% of first-time users reaching the app's home screen and 37% accessing one of the app's primary content areas. CONCLUSIONS These findings suggest that PTSD Coach has achieved substantial and sustained reach in the population, is being used as intended, and has been favorably received. PTSD Coach is a unique platform for the delivery of mobile mental health education and treatment, and continuing evaluation and improvement of the app could further strengthen its public health impact.
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Affiliation(s)
- Jason E Owen
- National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States
| | - Beth K Jaworski
- National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States
| | - Eric Kuhn
- National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States
| | - Kerry N Makin-Byrd
- National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States
| | - Kelly M Ramsey
- National Center for PTSD Dissemination & Training Division Department of Veterans Affairs Palo Alto Health Care System Menlo Park, CA United States
| | - Julia E Hoffman
- Mental Health Services US Department of Veterans Affairs Menlo Park, CA United States
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