Understanding Reproductive Healthcare and Outcomes Among Women Veterans: A Review of Recent Research and Future Opportunities

Presentation focused on reproductive health issues among women Veterans in VA care. In particular, examines patterns of healthcare utilization for gender-specific conditions among women Veterans, as well as beliefs and preferences for reproductive health care services within the VA healthcare system. Then explores innovative new research aimed at better understanding reproductive health services and outcomes among women Veterans

Sourcebook: Women Veterans in the Veterans Health Administration. Volume 2: Sociodemographics and Use of VHA and Non-VA Care (Fee)

Describes sociodemographic characteristics and health care utilization patterns of women Veteran patients in the VHA. Its primary purpose is to present data to inform policy and program planning as VHA implements and evaluates new ways of providing care to women Veterans. Provides data about women residing in rural versus urban areas and by examining use of health care through VHA’s “Non-VA Care (Fee)” system, which is comprised of services provided to Veterans by non-VHA providers but reimbursed through VHA. Produced by the Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration, Department of Veterans Affairs, Washington DC

Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain

Introduction: Smoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. Methods: The Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. Results: The 371 participants are 88% male, a median age of 60 years old (range 24-82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as Fair (40%) to Poor (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). Conclusions: PASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities

Perinatal Symptoms and Treatment Engagement in Female Veterans

INTRODUCTION: Women veterans using Veterans Health Care Administration maternity benefits have a high prevalence of mental health disorders, including depression, PTSD, and anxiety. Additionally, women with psychiatric histories often experience a relapse or worsening of symptoms during pregnancy and postpartum. Adequate perinatal mental healthcare engagement is critical to optimizing outcomes for mother and child. MATERIALS AND METHODS: This study evaluated psychiatric symptom severity and predictors of women veteran\u27s mental health treatment engagement during pregnancy and postpartum at the VA North Texas Health Care System. Seventy women using Veterans Health Administration were assessed longitudinally via chart review and interviews (including the Edinburgh Postnatal Depression Scale) during pregnancy and postpartum. A Friedman test was used to evaluate the change in symptom severity during (1) the 6 months before pregnancy, (2) pregnancy, and (3) postpartum. Multivariate logistic regressions were used to determine predictors of attending outpatient mental health appointments. Potential predictors examined included sociodemographic factors, symptoms of depression, history of military sexual assault, presence of a pre-pregnancy psychiatric diagnosis, and attendance of mental health appointments before pregnancy. RESULTS: Approximately 40% of participants demonstrated at least mild psychiatric symptoms before pregnancy, and symptom severity did not significantly change across the perinatal period (pre-pregnancy, pregnancy, and postpartum) X2 (2, n = 70) = 3.56, P = .17. Depressive symptoms during the 2nd or 3rd trimester were a significant predictor for attendance of mental health appointments during both pregnancy (OR = 1.18, 95% CI, 1.04 to 1.34) and postpartum (OR = 1.18, 95% CI, 1.02 to 1.36). An active psychiatric diagnosis during the 6 months before pregnancy was also a significant predictor of attendance following delivery (OR = 14.63, 95% CI, 1.55 to 138.51). CONCLUSION: Our results demonstrate that women with prior histories of mental health conditions will continue to be symptomatic, and this is a good predictor of mental health treatment engagement during the perinatal period. This work is written by (a) US Government employee(s) and is in the public domain in the US

A birth cohort analysis to study dog walking in adolescence shows no relationship with objectively measured physical activity

Physical inactivity during childhood and adolescence is a serious health concern. There are few studies of the activity undertaken by adolescents when walking with the family dog, and the effect of this on objectively measured physical activity levels. Objective measures of physical activity using accelerometers were recorded at age 11-12, 13-14, and 15-16 years in the Avon Longitudinal Study of Parents and Children (ALSPAC) (ALSPAC, UK) birth cohort during the 2000s. Family pet ownership was collected retrospectively using a questionnaire at age 18 years, for the ages 7, 11, 13, and 15 years. In addition, approximate frequency per week of walks undertaken with dogs were also reported. Multilevel, multivariable modeling was used to investigate the relationship between dog ownership and dog walking status, and physical activity outcomes. There were a total of 4,373 complete data observations for use in 2,055 children. Reported participation in dog walking tended to increase during adolescence, as did dog ownership. The majority of who own dogs reported walking them either 2-6 times/week (range 39-46%) or never (range 27-37%). A small minority (7-8%) reported walking their dog every day. Most reported never walking any other dog either (94-87%). We found no evidence for an association between dog ownership or reported dog walking, and objectively measured physical activity (counts per minute, P = 0.3, or minutes of moderate-to-vigorous physical activity, P = 0.7) during adolescence. This study provides no evidence to support a relationship between adolescent dog ownership and physical activity, and demonstrates the importance of using objective activity measures and considering dog walking rather than just dog ownership.</p

Understanding Maternity Care Coordination for Women Veterans Using an Integrated Care Model Approach

BACKGROUND: An increasing number of women veterans are using VA maternity benefits for their pregnancies. However, because the VA does not offer obstetrical care, women must seek maternity care from non-VA providers. The growing number of women using non-VA care has increased the importance of understanding how this care is integrated with ongoing VA medical and mental health services and how perceptions of care integration impact healthcare utilization. Therefore, we sought to understand these relationships among a sample of postpartum veterans utilizing VA maternity benefits. METHODS: We fielded a modified version of the Patient Perceptions of Integrated Care survey among a sample of postpartum veterans who had utilized VA maternity benefits for their pregnancies (n = 276). We assessed relationships between perceptions of six domains of patient-reported integrated care, indicating how well-integrated patients perceived the care received from VA and non-VA clinicians, and utilization of mental healthcare following pregnancy. RESULTS: Domain scores were highest for items focused on VA care, including test result communication and VA provider\u27s knowledge of patient\u27s medical conditions. Scores were lower for obstetrician\u27s knowledge of patient\u27s medical history. Women with depressive symptom scores indicative of depression rated test result communication as highly integrated, while women who received mental healthcare following pregnancy had low integrated care ratings for the Support for Medication and Home Health Management domain, indicating a lack of support for mental health conditions following pregnancy. DISCUSSION: Among a group of postpartum veterans, poor ratings of integrated care across some domains were associated with higher rates of mental healthcare use following pregnancy. Further assessment of integrated care by patients may assist VA providers and policymakers in developing systems to ensure integrated care for veterans who receive care outside the VA

Developing Age-Friendly Cities: An evidence-based evaluation tool

Recent years have seen a proliferation of initiatives aimed at enhancing the age-friendliness of urban settings. The World Health Organization's (WHO) global Age-Friendly Cities (AFC) programme has been central to these. Cities seeking to become more age-friendly need reliable ways of assessing their efforts. This article describes an evidence-based evaluation tool for age-friendly initiatives whose development was informed by fieldwork in Liverpool/UK. The tool complements existing assessment frameworks, including those provided by WHO, by paying particular attention to the structures and processes underlying age-friendly initiatives. It reflects the complexity of age-friendliness by reconciling a focus on breadth with detail and depth, and it allows for a highly accessible visual presentation of findings. Using selected examples from Liverpool, the article illustrates how the evaluation tool can be applied to guide policy and practice with an age-friendly focus in different urban contexts. Pilot testing in further settings is underway to refine the tool as a practical method for evaluation and for supporting city-level decision making. Key words: Age-Friendly City; evaluation tool; ageing; urbanisation; complex intervention

Improving Care Coordination for Veterans Within VA and Across Healthcare Systems

The VA faces a plethora of care coordination challenges. Many Veterans have multiple conditions and providers, and many get a portion of their care in the community, a number that will only grow as recent legislation expands options for private care. These challenges have spawned new VA initiatives for redesigning care to meet them, described in this supplement in an editorial by Hosenfeld and colleagues. The VA Health Services Research and Development (HSR&D) service, in partnership with VA’s Office of Primary Care, and Office of Community Care, sponsored a State of the Art (SOTA) conference with the goals of (a) summarizing what is known about care coordination relevant to Veterans’ care; (b) identifying care coordination approaches ready for wider dissemination and implementation within VA; and (c) identifying a research agenda and recommendations, as appropriate, for increasing VA’s knowledge and use of evidence-based approaches for coordinating care. Held in March 2018, the SOTA was jointly planned by VA HSR&D and Offices of Primary Care, Community Care, Nursing Services, and Care Management and Social Work, and convened VA and non-VA health services researchers, clinicians, and policy makers. This supplement presents recommendations from the SOTA as well as original research papers on care coordination strategies within VA and between VA and non-VA providers

Pregnancy and Mental Health Care Among Women Veterans Returning from Iraq and Afghanistan

Presentation looking at pregnancy and mental health care in the VA system. Documents a study examining the prevalence of pregnancy care and comparing the mental health diagnoses among pregnant and non-pregnant women in VA care. Then examining the degree to which pregnant veterans receive VA mental health care during their pregnancy. Concludes that pregnant women veterans using VA care have a substantial mental health burden

Newborn Outcomes Among Veterans Utilizing VHA Maternity Benefits, 2016-2020

INTRODUCTION: Public Law 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act amended the Veterans Health Administration\u27s (VHA) medical benefits package to include 7 days of medical care for newborns delivered by Veterans. We examined the newborn outcomes among a cohort of women Veterans receiving VHA maternity benefits and care coordination. MATERIALS AND METHODS: We conducted a secondary analysis of phone interview data from Veterans enrolled in the COMFORT (Center for Maternal and Infant Outcomes Research in Translation) study 2016-2020. Multivariable regression estimated associations with newborn outcomes (preterm birth; low birthweight). RESULTS: During the study period, 829 infants were born to 811 Veterans. Mothers reported excellent health for 94% of infants. The prevalence of preterm birth was slightly higher in our cohort (11% vs. 10%), as were low birthweight (9%) deliveries, compared to the general population (8.28%). Additionally, 42% of infants in our cohort required follow-up care for non-routine health conditions; 11% were uninsured at 2 months of age. Adverse newborn outcomes were more common for mothers who were older in age, self-identified as non-white in race and/or of Hispanic ethnicity, had a diagnosis of posttraumatic stress disorder, or had gestational comorbidities. CONCLUSIONS: The current VHA maternity coverage appears to be an effective policy for ensuring the well-being and health care coverage for the majority of Veterans and their newborns in the first days of life, thereby reducing the risk of inadequate prenatal and neonatal care. Future research should examine costs associated with extending coverage to 14 days or longer, comparing those to the projected excess costs of neonatal health problems. VHA policy should continue to support expanding care and resources through the Maternity Care Coordinator model