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Shah, RT, i WM Parker. "Differences In The Utilization Of Preventive Services For United States Veterans And Non-Veterans". Value in Health 17, nr 3 (maj 2014): A138. http://dx.doi.org/10.1016/j.jval.2014.03.803.
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Kostyshyn, Emilia, Vita Hrytsaniuk i Yuliia Shevtsiv. "USA EXPERIENCE REGARDING THE REINTEGRATION OF WAR VETERANS INTO CIVILIAN LIFE". Social work and social education, nr 1(12) (30.04.2024): 11–18. http://dx.doi.org/10.31499/2618-0715.1(12).2024.305055.
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The article summarizes the experience of the United States regarding the reintegration of veterans into civilian life, namely: the peculiarities of regulatory and legal regulation and the main directions of veteran policy. It was established that the American legislation uses two terms –«veteran» and «active military serviceman», while in Ukraine – «combatant», «military serviceman», «war veteran», «war participant». The American practice of military reintegration into civilian life involves mandatory participation in the Transition Assistance Program (TAP). The main directions of military reintegration into civilian life in the USA, which are under the competence of the Department of Defense, the Department of Veterans Affairs and the Department of Labor, are: social adaptation; psychological support; professional retraining; support with housing. Social adaptation includes social communication, social support and formation of new social skills. Psychological support includes specialized support and treatment. Professional retraining of veterans is the acquisition of new professional qualifications through the acquisition of additional education or skills. Support with housing includes providing a loan for the purchase of housing, maintenance and adaptation of houses to new requirements in case of disability.It has been established that the USA is a country where «military social work» was formed, which is understood as a specialized practice of social work that provides support to military personnel, war veterans and their family members. Military social workers provide a range of services (counseling, crisis intervention, supervision), conduct training and coaching, and organize presentations of special client health support events to colleagues at all levels. Regarding the provision of social benefits, the USA has an exclusive approach to veterans policy – welfare programs for veterans operate separately from programs for the general population. The current system of benefits for veterans in the United States is complex.
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Finlay, Andrea K., Jim McGuire, Jennifer Bronson i Shoba Sreenivasan. "Veterans in Prison for Sexual Offenses: Characteristics and Reentry Service Needs". Sexual Abuse 31, nr 5 (10.08.2018): 560–79. http://dx.doi.org/10.1177/1079063218793633.
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Among prison-incarcerated men in the United States, more veterans (35%) have a sexual offense conviction than nonveterans (23%). Limited research has investigated factors explaining the link between military service and sexual offending. Nationally representative data from prison-incarcerated men ( n = 14,080) were used to examine the association between veteran status and sexual offenses, adjusting for demographic, childhood, and clinical characteristics. Veterans had 1.35 higher odds (95% confidence interval = [1.12, 1.62], p < .01) of a sexual offense than nonveterans. Among veterans, those who were homeless or taking mental health medications at arrest had lower odds and veterans with a sexual trauma history had higher odds of a sexual offense compared with other offense types. Offering mental health services in correctional and health care settings to address trauma experiences and providing long-term housing options can help veterans with sexual offenses as they transition from prison to their communities.
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Aristide, Gibson. "A Qualitative Study of Disability in Minority Veterans and Their Utilization of the VA Health System". International Journal of Scientific Research and Management (IJSRM) 11, nr 12 (2.12.2023): 904–62. http://dx.doi.org/10.18535/ijsrm/v11i12.mp01.
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Over time, as the United States army increased, white and minority citizens joined the military forces. This led to the establishment of the Veterans Bureau, and later the Veterans Administration, to care for the wounded soldiers. Although the nation had developed a system to provide services to veterans since the late 1700s, there has been a decline in utilization of y veteran service members in the modern day. The purpose of this phenomenological study is to investigate the causes behind the limited use of the mental health services provided by the VHA by minority veteran service members and to propose ways to improve these services. Additionally, another purpose was to examine any cases of discrimination against minority veteran service members based on interviews with participants and previous empirical literature. After conducting multiple interviews, the status of patient satisfaction, degree of reliance on VHA medical facilities, perception of efficiency of services, and patronage XIII were analyzed. In summary, previous empirical literature had indicated that minority veteran service members were more likely to face discrimination because of racial bias. However, today, that is not largely the case. Rather, most of the minority veteran service members interviewed did not face discrimination and they were content with the health services offered. While some of the interviewees did claim that they faced some acts of discrimination, the overwhelming majority did not. These findings suggest that most minority veteran service members do not face discrimination and that they are actively interested in seeking VH healthcare services. Nevertheless, understanding minority veteran service members may enable healthcare providers to provide them with customized healthcare sections.
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Wilkinson, Renae, Thomas Byrne, Richard G. Cowden, Katelyn N. G. Long, John H. Kuhn, Howard K. Koh i Jack Tsai. "First Decade of Supportive Services for Veteran Families Program and Homelessness, 2012–2022". American Journal of Public Health 114, nr 6 (czerwiec 2024): 610–18. http://dx.doi.org/10.2105/ajph.2024.307625.
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As homelessness remains an urgent public health crisis in the United States, specific programs in the US Department of Veterans Affairs (VA) system may serve as a roadmap for addressing it. We examine lessons learned from the first decade (2012–2022) of the Supportive Services for Veteran Families (SSVF) program, a cornerstone in the VA continuum of homeless services aimed at both preventing homelessness among those at risk and providing rapid rehousing for veterans and their families who are currently experiencing homelessness. Drawing on information from annual reports and other relevant literature, we have identified 3 themes of SSVF that emerged as features to comprehensively deliver support for homeless veterans and their families: (1) responsiveness and flexibility, (2) coordination and integration, and (3) social resource engagement. Using these strategies, SSVF reached nearly three quarters of a million veterans and their families in its first decade, thereby becoming one of the VA’s most substantial programmatic efforts designed to address homelessness. We discuss how each feature might apply to addressing homelessness in the general population as well as future research directions. ( Am J Public Health. 2024;114(6):610–618. https://doi.org/10.2105/AJPH.2024.307625 )
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Anderson, Ekaterina, Renda Soylemez Wiener, Brianne Molloy-Paolillo, Megan McCullough, Bo Kim, J. Irene Harris, Seppo T. Rinne, A. Rani Elwy i Barbara G. Bokhour. "Using a person-centered approach in clinical care for patients with complex chronic conditions: Perspectives from healthcare professionals caring for Veterans with COPD in the U.S. Veterans Health Administration’s Whole Health System of Care". PLOS ONE 18, nr 6 (23.06.2023): e0286326. http://dx.doi.org/10.1371/journal.pone.0286326.
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Background The largest nationally integrated health system in the United States, the Veterans Health Administration (VHA), has been undergoing a transformation toward a Whole Health (WH) System of Care. WH Clinical Care, a component of this system, includes holistically assessing the Veteran’s life context, identifying what really matters to the Veteran, collaboratively setting and monitoring personal health and well-being goals, and equipping the Veteran with access to conventional and complementary and integrative health resources. Implementation of WH Clinical Care has been challenging. Understanding healthcare professionals’ perspectives on the value of and barriers and facilitators to practicing WH Clinical Care holds relevance for not only VHA’s efforts but also other health systems, in the U.S. and internationally, that are engaged in person-centered care implementation. Objectives We sought to understand perspectives of healthcare professionals at VHA on providing WH Clinical Care to Veterans with COPD, as a lens to understand the broader issue of WH Clinical Care for Veterans living with complex chronic conditions. Design We interviewed 25 healthcare professionals across disciplines and services at a VA Medical Center in 2020–2021, including primary care providers, pulmonologists, palliative care providers, and chaplains. Interview transcripts were analyzed using qualitative content analysis. Key results Each element of WH Clinical Care raised complex questions and/or concerns, including: (1) the appropriate depth/breadth of inquiry in person-centered assessment; (2) the rationale for elicitation of what really matters; (3) the feasibility and appropriate division of labor in personal health goal setting and planning; and (4) challenges related to referring Veterans to a broad spectrum of supportive services. Conclusions Efforts to promote person-centered care must account for healthcare professionals’ existing comfort with its elements, advocate for a team-based approach, and continue to grapple with the conflicting structural conditions and organizational imperatives.
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Raad, Jason H., Elizabeth Tarlov, Abel N. Kho i Dustin D. French. "Health Care Utilization Among Homeless Veterans in Chicago". Military Medicine 185, nr 3-4 (12.11.2019): e335-e339. http://dx.doi.org/10.1093/milmed/usz264.
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Abstract Introduction The U.S. Department of Veterans Affairs (VA), the single largest health care system in the United States, provides comprehensive medical and behavioral health services to more than 9 million Veterans. The size and scope of the VA’s system of care allow health care providers, policymakers, and community stakeholders to conduct detailed analyses of health care utilization among Veterans; however, these analyses do not include health care encounters that occur outside VA. Although many Veterans obtain care in non-VA settings, understanding health care utilization among vulnerable populations of Veterans, including those who are homeless or at risk of becoming homeless, is needed to identify potential opportunities to enhance access and reduce fragmentation of care. Materials and Methods VA administrative data were merged with data from the Chicago HealthLNK Data Repository to identify Veterans eligible for VA services who were homeless, or at risk of becoming homeless, in the greater Chicago metropolitan area for the years 2010–2012. Results During the 3-year study period, about 208,554 Veterans were registered for care at two VA medical centers located in the City of Chicago and an adjacent suburb. Of those, 13,948 were identified as homeless or at risk of becoming homeless. Results suggest that 17% (n = 2,309) of Veterans in this sample received some or all of their care in the community. Much of the care these Veterans received was for chronic health conditions, substance use, and mental health disorders. Conclusions Veterans eligible for VA servicers who are homeless, or at risk of becoming homeless, frequently sought care in the community for a variety of chronic health conditions. Health information exchanges and partner-based registries may represent an important tool for identifying vulnerable Veteran populations while reducing duplication of care.
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Gawron, Lori, April Mohanty, Jennifer Kaiser i Adi Gundlapalli. "Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans". Seminars in Reproductive Medicine 36, nr 06 (listopad 2018): 361–70. http://dx.doi.org/10.1055/s-0039-1678749.
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AbstractReproductive-age women are a fast-growing component of active-duty military personnel who experience deployment and combat more frequently than previous service-era women Veterans. With the expansion of the number of women and their roles, the United States Departments of Defense and Veterans Affairs have prioritized development and integration of reproductive services into their health systems. Thus, understanding associations between deployments or combat exposures and short- or long-term adverse reproductive health outcomes is imperative for policy and programmatic development. Servicewomen and women Veterans may access reproductive services across civilian and military or Veteran systems and providers, increasing the need for awareness and communication regarding deployment experiences with a broad array of providers. An example is the high prevalence of military sexual trauma reported by women Veterans and the associated mental health diagnoses that may lead to a lifetime of high risk-coping behaviors that increase reproductive health risks, such as sexually transmitted infections, unintended pregnancies, and others. Care coordination models that integrate reproductive healthcare needs, especially during vulnerable times such as at the time of military separation and in the immediate postdeployment phase, may identify risk factors for early intervention with the potential to mitigate lifelong risks.
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Kaufman, Carol E., Laura Grau, Rene Begay, Margaret Reid, Cynthia W. Goss, Bret Hicken, Jay H. Shore i Joan O’Connell. "American Indian and Alaska Native veterans in the Indian Health Service: Health status, utilization, and cost". PLOS ONE 17, nr 4 (1.04.2022): e0266378. http://dx.doi.org/10.1371/journal.pone.0266378.
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Purpose Many rural American Indian and Alaska Native (AIAN) veterans receive care from the Indian Health Service (IHS). United States Department of Veterans Affairs (VA) has reimbursement agreements with some IHS facilities and tribal programs and seeks to expand community partnerships in tribal areas, but details of how AIAN veterans use IHS are unknown. We aimed to assess the health status, service utilization patterns, and cost of care of veterans who use IHS. Methods We used comprehensive and integrated IHS data to compare health status, health service utilization and treatment cost of veterans (n = 12,242) to a matched sample of non-veterans (n = 12,242). We employed logistic, linear, or negative binomial regressions as appropriate, by sex and overall. Findings Compared to non-veterans, veterans had lower odds of having hypertension, renal disease, all-cause dementia, and alcohol or drug use disorders, but had similar burden of other conditions. In service utilization, veterans had lower hospital inpatient days; patterns were mixed across outpatient services. Unadjusted treatment costs for veterans and non-veterans were $3,923 and $4,145, respectively; veteran adjusted treatment costs were statistically lower. Differences in significance by sex were found for health conditions and service use. Conclusions AIAN veterans, compared to AIAN non-veterans, were not less healthy, nor did they require more intensive or more costly care under IHS. Our results indicate the viability and importance of expanding IHS-VA partnerships in community care.
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Solimeo, Samantha, i Bret Hicken. "STAKEHOLDER PERSPECTIVES ON DESIGN, IMPLEMENTATION, AND SUSTAINMENT OF SERVICES FOR OLDER VETERANS". Innovation in Aging 3, Supplement_1 (listopad 2019): S755. http://dx.doi.org/10.1093/geroni/igz038.2772.
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Abstract A majority of United States Veterans are older adults, compelling healthcare systems such as Veterans Health Administration to attend to their unique needs when designing and implementing programs for workforce development and service delivery. In this symposium authors will present findings from four studies examining how older Veterans’ needs and preferences affect implementation and sustainment in a variety of settings. Presenters demonstrate how: 1) understanding Veterans’ perspectives and preferences for measuring functional status may inform the improvement of care coordination in the primary care setting; 2) the role of population characteristics in implementation of geriatric patient centered medical home teams (i.e., GeriPACTs); 3) the interaction of patient, provider, and delivery system information needs in limiting sustainment of diverse initiatives to improve osteoporosis screening and management for Veterans; and 4) the factors affecting transferability and sustainment of rural and geriatrics-focused quality improvement initiatives beyond local settings. Beyond their focus on how older adults’ needs are reflected or shape implementation, the studies illustrate the application of qualitative data to clinical practice and workforce development.
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Arno, Claudia. "Proportional Response: The Need for More—And More Standardized—Veterans’ Courts". University of Michigan Journal of Law Reform, nr 48.4 (2015): 1039. http://dx.doi.org/10.36646/mjlr.48.4.proportional.
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Over the past two decades, judges and legislators in a number of states have recognized significant shortcomings in the ways traditional systems of criminal corrections address cases involving criminal offenders who are veterans of the U.S. armed services. This recognition has come at a time when policy-makers have similarly recognized that, for certain subsets of criminal offenders, “diversionary” programs may achieve better policy results than will traditional criminal punishment. In accordance with these dual recognitions, some states have implemented systems of veterans’ courts, in which certain offenders, who are also U.S. veterans, are diverted into programs that provide monitoring, training, and occupational and psychological counseling in lieu of imprisonment. Because these veterans’ courts have been created on an ad hoc, state-by-state basis, it remains unclear exactly how such courts should be implemented in order to be most effective. This Note argues that the evidence currently available suggests that veterans’ courts are a good policy choice, in that they can have a positive impact on state criminal systems by reducing recidivism among offenders and by conserving state resources. Accordingly, this Note argues, states should pursue diversionary programs for at least some subset of U.S. veterans because: (1) the U.S. government has already invested significant resources in training veterans and helping them to develop skills; (2) in many cases the behavior that leads to a veteran being incarcerated stems at least in part from service-related trauma, suggesting that addressing the trauma may correct the behavior; and (3) as a matter of equity, those who have served in defense of the United States may be due special consideration in light of their special sacrifices. This said, given the difficulties inherent in determining which veterans, in which cases, should be afforded the benefits of these diversionary programs, that there is no coordinated state action in this area, and that many of the potential benefits of veterans’ courts can best—or perhaps only—be realized through a standardized, uniform model, the federal government should promulgate standards for implementing such programs in state court systems.
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Van Slyke, Ryan D., i Nicholas J. Armstrong. "Communities Serve: A Systematic Review of Need Assessments on U.S. Veteran and Military-Connected Populations". Armed Forces & Society 46, nr 4 (20.05.2019): 564–94. http://dx.doi.org/10.1177/0095327x19845030.
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Military veterans and their families face a multiplicity of challenges once they transition from service. Even though more American private and public-sector organizations are engaged in studying the needs of veterans and their families through need assessments, few assessments are comprehensive analyses of the challenges they face. This systematic review of 61 need assessments from 2007-2018 in the United States summarizes findings on 18 veterans issues. While most studies addressed issues relating to accessing U.S. Department of Veterans Affairs health and benefit services, mental health, employment, and homelessness, gaps in the literature emerged, particularly regarding ethnic and sexual minority, rural and elderly veterans, and National Guard/Reserve servicemembers. Large cities and states with varying degrees of military presence were frequent regions of study, with national think tanks, nonprofit organizations, and public universities conducting most need assessments. Future assessments should address persistent inequities in coverage among communities and topics of study using mixed-method research and survey design.
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Landes, Scott, i Jennifer Piazza. "MORTALITY RISK AMONG OLDER VETERANS AND NONVETERANS: THE IMPORTANCE OF COMBAT STATUS". Innovation in Aging 6, Supplement_1 (1.11.2022): 150. http://dx.doi.org/10.1093/geroni/igac059.597.
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Abstract Over 17.4 million Americans have served in the U.S. armed forces. Although long-term mortality risk is reported to be higher among older veterans than nonveterans, research does differentiate whether there is variation by combat status. This study examined later-life mortality rates among nonveterans, noncombat veterans, and combat veterans. Data were from Wave 2 of the Midlife Development in the United States Survey (N = 4,633). Participants included 3832 nonveterans, 584 noncombat veterans, and 217 combat veterans. Mortality rates did not differ when comparing nonveterans and noncombat veterans. Combat veterans, however, had a higher risk of mortality than did than nonveterans. Combat experience is a determinant of long-term mortality risk among veterans. Future studies should account for combat status when comparing health and mortality between veterans and nonveterans. Because of their heightened mortality risk, combat veterans should be provided with additional services during and after their time in the armed forces.
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Bouldin, Erin D., Roxana Delgado, Kimberly Peacock, Willie Hale, Ali Roghani, Amira Y. Trevino, Mikayla Viny, David W. Wetter i Mary Jo Pugh. "Military Injuries—Understanding Posttraumatic Epilepsy, Health, and Quality-of-Life Effects of Caregiving: Protocol for a Longitudinal Mixed Methods Observational Study". JMIR Research Protocols 11, nr 1 (5.01.2022): e30975. http://dx.doi.org/10.2196/30975.
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Background Veterans with posttraumatic epilepsy (PTE), particularly those with comorbidities associated with epilepsy or traumatic brain injury (TBI), have poorer health status and higher symptom burden than their peers without PTE. One area that has been particularly poorly studied is that of the role of caregivers in the health of veterans with PTE and the impact caring for someone with PTE has on the caregivers themselves. Objective In this study, we aim to address the following: describe and compare the health and quality of life of veterans and caregivers of veterans with and without PTE; evaluate the change in available supports and unmet needs for services among caregivers of post-9/11 veterans with PTE over a 2-year period and to compare support and unmet needs with those without PTE; and identify veteran and caregiver characteristics associated with the 2-year health trajectories of caregivers and veterans with PTE compared with veterans without PTE. Methods We conducted a prospective cohort study of the health and quality of life among 4 groups of veterans and their caregivers: veterans with PTE, nontraumatic epilepsy, TBI only, and neither epilepsy nor TBI. We will recruit participants from previous related studies and collect information about both the veterans and their primary informal caregivers on health, quality of life, unmet needs for care, PTE and TBI symptoms and treatment, relationship, and caregiver experience. Data sources will include existing data supplemented with primary data, such as survey data collected at baseline, intermittent brief reporting using ecological momentary assessment, and qualitative interviews. We will make both cross-sectional and longitudinal comparisons, using veteran-caregiver dyads, along with qualitative findings to better understand risk and promotive factors for quality of life and health among veterans and caregivers, as well as the bidirectional impact of caregivers and care recipients on one another. Results This study was approved by the institutional review boards of the University of Utah and Salt Lake City Veterans Affairs and is under review by the Human Research Protection Office of the United States Army Medical Research and Development Command. The Service Member, Veteran, and Caregiver Community Stakeholders Group has been formed and the study questionnaire will be finalized once the panel reviews it. We anticipate the start of recruitment and primary data collection by January 2022. Conclusions New national initiatives aim to incorporate the caregiver into the veteran’s treatment plan; however, we know little about the impact of caregiving—both positive and negative—on the caregivers themselves and on the veterans for whom they provide care. We will identify specific needs in this understudied population, which will inform clinicians, patients, families, and policy makers about the specific impact and needs to equip caregivers in caring for veterans at home. International Registered Report Identifier (IRRID) PRR1-10.2196/30975
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Bosmia, Anand N., i John D. Christein. "Charles Bernard Puestow (1902–1973): American surgeon and commander of the 27th Evacuation Hospital during the Second World War". Journal of Medical Biography 25, nr 3 (27.10.2015): 147–52. http://dx.doi.org/10.1177/0967772015608052.
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Dr. Charles Bernard Puestow (1902–1973) was an American surgeon who is well known for developing the longitudinal pancreaticojejunostomy, which is known as the “Puestow procedure” in his honor. Puestow served in the American military during the Second World War and commanded the 27th Evacuation Hospital, which provided medical and surgical services to wounded individuals in Europe and North Africa. In 1946, he founded the surgical residency training program at the Hines Veterans Hospital, which was the first such program in the United States based at a veterans hospital.
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Prathibha, Saranya, Anders Westanmo, Jane Hui, Katie Westanmo, Amy Gravely, Todd Tuttle i Christopher LaRocca. "Breast Cancer and Women Veterans: What Is the Impact of Mental Health on Screening Rates?" Medicines 10, nr 1 (20.12.2022): 1. http://dx.doi.org/10.3390/medicines10010001.
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Background: The proportion of women Veterans are increasing and, as such, access to high-quality breast cancer care is important. Prior studies have shown that rural location, age, and a mental health diagnosis negatively impact breast cancer screening rates. Methods: We aimed to retrospectively assess the impact of these risk factors on breast cancer screening adherence rates among Veterans at our institution. Women who were eligible for breast cancer screening per the United States Preventative Services Taskforce guidelines were included. Results: Of 2321 women, overall adherence was 78.2%. There were no significant differences in screening rates between races, various age groups, geographical distribution, and having anxiety or post-traumatic stress disorder (PTSD). However, Veterans with a diagnosis of depression were more likely to adhere to screening guidelines. Having multiple mental health diagnoses was also not a negative risk factor. Conclusions: Our Veteran population’s adherence rates are higher than the national average and rural location, race, age, and certain mental health disorders did not negatively affect adherence to screening mammography. Though more research is needed, screening reminders from our women’s health coordinator may have improved adherence rates and lowered disparities.
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Cassatt, Sarah, i Elizabeth Parker. "EFFICACY OF MALNUTRITION SCREENING AMONG OLDER VETERANS AT AN URBAN VA HOSPITAL". Innovation in Aging 7, Supplement_1 (1.12.2023): 1025. http://dx.doi.org/10.1093/geroni/igad104.3294.
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Abstract Nearly half of the Veteran population is >65 years. Older Veterans are at increased risk of malnutrition associated with increased mortality, morbidity, length of stay, and readmissions. Malnutrition-focused quality measures are needed to combat this public health issue. The purpose of this study was to identify gaps in malnutrition screening at an urban VA facility. Chart auditing was conducted for all medical admissions during 72 hour periods across 14 months. Auditing determined if nutrition screening was completed, with an admission weight, and if nutrition was consulted for nutritionally compromised Veterans. Screening was conducted using the Malnutrition Screening Tool (MST). Additionally, estimated prevalence of nutritionally compromised Veterans was assessed using auditing data from 30 days. Audit data showed that on average only 57.4% (n=458) of Veterans admitted for inpatient care were screened correctly. Of those screened incorrectly, the three most common errors were 1) not collecting a weight on admission (N=82 (42.1%)); 2) inaccurate weight change interpretations (N=41 (21%)); 3) failure to refer nutritionally at-risk Veterans to nutrition services (N=38 19.5%)). Prevalence auditing demonstrated over 1/3 of Veterans were nutritionally compromised at the start of their hospitalization (36.43%, (N=295)). With an increasingly aging population in the United States there is a focus on shifting to value based payment systems. The new CMS Global Composite Malnutrition Score will include evaluation of hospitals malnutrition screening processes. There is a significant opportunity to close these gap areas and to adopt clinically relevant best practices to provide nutrition care earlier to at risk Veterans.
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Haque, Lamia, i Robert Rosenheck. "Mental health and addiction service use among United States veterans with liver disease nationally in the Veterans Health Administration". Journal of Public Mental Health 20, nr 3 (5.05.2021): 191–200. http://dx.doi.org/10.1108/jpmh-07-2020-0088.
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Purpose While many studies have shown that liver diseases (LD) can be caused or exacerbated by substance use disorders (SUD), few have examined the proportion of adults with LD and SUD who receive mental health and addiction treatment or correlates of such use. Design/methodology/approach Using national Fiscal Year (FY) 2012 data from the United States Veterans Health Administration (VHA), the authors studied all 43,246 veterans diagnosed with both LD and SUD in FY 2012 and compared those who received mental health treatment (n = 30,456; 70.4%) to those who did not (n = 12,790; 29.6%). Findings Veterans who received mental health treatment were less like to be older than 75 years of age, more likely to have served during recent Middle East conflicts (Operation Iraqi Freedom or Operation Enduring Freedom), more likely to have been recently homeless and to have drug dependence as contrasted with alcohol dependence when compared with those who did not receive mental health treatment. Although the majority, 70.4%, received mental health treatment, only 30.6% of the total received specialized addiction treatment, and these veterans were more likely to experience homelessness and have drug dependence diagnoses. Originality/value This is the first study as per the authors’ best knowledge that broadly examines mental health and addiction treatment received by veterans with LD and SUD. High rates of mental health treatment in this population likely reflect the integrated nature of the VHA and its emphasis on providing comprehensive services to homeless veterans. Further research is needed to identify barriers to specialized addiction treatment in this population.
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Bourne, Garrett, Jennifer Bail, John Dell'Italia, Nichole Tanner, Nicholas Maurice i Devika Govind Das. "Lung cancer screening among women Veterans within the Veterans’ Health Administration." Journal of Clinical Oncology 42, nr 16_suppl (1.06.2024): 10537. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.10537.
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10537 Background: Despite advancements in survival rates, lung cancer remains the leading cause of cancer-related deaths among women in the United States (US). In response to this challenge, the United States Preventive Services Task Force (USPSTF) issued updated guidelines in 2021 to broaden the pool of eligible candidates for lung cancer screening (LCS). Pioneering initiatives, such as the Lung Cancer Screening Demonstration Project (LCSDP) launched by the Veterans Affairs (VA) in 2012, have played a pivotal role in evaluating the feasibility of implementing Low-Dose Computed Tomography (LDCT) at eight Veterans Affairs Medical Centers (VAMC). Subsequently, the program has undergone substantial expansion. Projections within the veteran community indicate a notable increase in the proportion of women veterans, from 11% in 2023 to an anticipated 18% in 2048. However, scant information is currently available regarding the lung cancer screening patterns within this expanding demographic. Methods: Women veterans ages 55 -80, current or former smokers from 2015- 2021 were identified through the VA corporate data warehouse (CDW). ICD 9/10 codes were used to identify women veterans with a lung cancer diagnosis. Diagnoses were verified via chart review. Data were analyzed using R Studio software. Results: Of the women veterans identified (n=44,342), 10,623 received LCS (24%) and 942 (2%) had a primary diagnosis of lung cancer. In the cohort of 942 women diagnosed, 286 (30%) had received lung cancer. Women veterans diagnosed with lung cancer tended to be aged >65 (55%), white (72%), single (72%), unemployed (71%), and urban dwelling (70%) within the southeastern US (35%). Compared to women veterans who did not receive LCS, those who did had higher rates of localized disease (47% vs 34%) and lower rates of metastatic disease (12% vs 19%). Factors associated with higher rates of LCS included mammography (60% vs 49%), a family history of lung cancer (4% vs 2%) and living in the southeastern US (46% vs 35%). It is to be noted that 23% of the women veterans who were screened lived in rural areas and 18.53% identified as black. 98.9% of the women had reported current or former tobacco use but the data on pack year history was missing in 87.6% of charts. Conclusions: While further progress can be made, it is notable that 24% of women veterans received LCS, surpassing national averages. This discrepancy underscores the potential to advance efforts in establishing a comprehensive and structured lung cancer screening initiative, thereby facilitating the equitable inclusion of historically marginalized groups, particularly minorities and rural populations. The findings emphasize the imperative to overcome existing impediments to nationwide enrollment and retention in LCS. Lastly, the study underscores the necessity for increased resource allocation towards tobacco cessation initiatives as an integral component of the broader expansion strategy.
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Fix, Gemmae, Aaron Seaman, Linda Nichols, Sarah Ono, Nicholas Rattray, Samantha Solimeo, Heather Schacht Reisinger i Traci Abraham. "Building a Community of Anthropological Practice: The Case of Anthropologists Working within the United States’ Largest Health Care System". Human Organization 82, nr 2 (21.04.2023): 169–81. http://dx.doi.org/10.17730/1938-3525-82.2.169.
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The disciplinary contribution of anthropologists employed outside traditional anthropology departments has been a topic of discussion and debate in the field for nearly a century. Alongside industry, nongovernmental, and nonprofit career paths, an increasing number of anthropologists have developed productive research careers outside of academic anthropology departments. The United States Department of Veterans Affairs (VA), which provides health care services to more than 9 million United States military veterans annually, is one federal employer that has become a professional home to many anthropologists. Anthropologists working in VA represent all four fields, have established roots in health services research, and have grown a national network of ethnographically-informed colleagues. These anthropologists constitute a Community of Practice that collaborates and contributes to scholarly discourse, health care operations, and policy. In this article, eight anthropologists with over 120 years of collective experience share insights into how our community of anthropological practice came into being, the organizational culture that sustains it, and the potential opportunities in health research for emerging scholars. Working at the intersection of multiple disciplines, this geographically dispersed community offers a viable model for anthropologists embedded within health care systems, in clinical academic settings, and learners seeking to broaden their understanding of anthropological praxis beyond anthropology departments.
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Sico, Jason J., Brian B. Koo, Anthony J. Perkins, Laura Burrone, Ali Sexson, Laura J. Myers, Stanley Taylor i in. "Impact of the coronavirus disease-2019 pandemic on Veterans Health Administration Sleep Services". SAGE Open Medicine 11 (styczeń 2023): 205031212311693. http://dx.doi.org/10.1177/20503121231169388.
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Objectives: To understand the impact of the coronavirus disease-2019 pandemic on sleep services within the United States Department of Veterans Affairs using separate surveys from “pre-COVID” and pandemic periods. Methods: Data from a pre-pandemic survey (September to November 2019) were combined with data from a pandemic-period survey (August to November 2020) to Veterans Affairs sleep medicine providers about their local sleep services within 140 Veterans Affairs facilities). Results: A total of 67 (47.9%) facilities responded to the pandemic online survey. In-lab diagnostic and titration sleep studies were stopped at 91.1% of facilities during the pandemic; 76.5% of facilities resumed diagnostic studies and 60.8% resumed titration studies by the time of the second survey. Half of the facilities suspended home sleep testing; all facilities resumed these services. In-person positive airway pressure clinics were stopped at 76.3% of facilities; 46.7% resumed these clinics. Video telehealth was either available or in development at 86.6% of facilities and was considered a lasting addition to sleep services. Coronavirus disease-2019 transmission precautions occurred at high rates. Sleep personnel experienced high levels of stress, anxiety, fear, and burnout because of the pandemic and in response to unexpected changes in sleep medicine care delivery. Conclusions: Sleep medicine services within the Veterans Affairs evolved during the pandemic with many key services being interrupted, including in-lab studies and in-person positive airway pressure clinics. Expansion and initiation of telehealth sleep services occurred commonly. The pandemic adversely affected sleep medicine personnel as they sought to maintain access to care.
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Johnson, Jean E., Corey L. Moore, Fariborz Aref, Andre L. Washington, Courtney Ward i Kelsey Webb. "National Survey of State Vocational Rehabilitation Agency and Veterans Affairs Interagency Collaborations: An Emerging Conceptual Framework for Co-Serving Veterans of Color with Disabilities". Journal of Applied Rehabilitation Counseling 48, nr 4 (1.12.2017): 54–64. http://dx.doi.org/10.1891/0047-2220.48.4.54.
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This national study examined the perceptions of state vocational rehabilitation agency (SVRA) administrators (N = 39) about SVRA and United States Department of Veterans Affairs Vocational Rehabilitation and Employment (VA-VR&E) Program co-service practices that could facilitate improved employment outcomes among veterans of color (i.e., African Americans, Native Americans or Alaskan Natives, Latinos, and Asian Americans or Pacific Islanders) with disabilities. The investigators collected data using a survey of promising co-service practices and collaborations, and their subsequent analysis yielded 11 key themes that were catalogued into the following five domains; job placement services, referral services, cultural diversity, co-service agreements, and co-agency procedures. Generated findings informed the development of an emerging conceptual framework for a new “SVRA and VA-VR&E Co- Service Model” presented herein that could be considered for future evaluation and adoption by these agencies.
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Pope, Annie R., Daniel E. Rodell i Ron L. Evans. "Program Review of Community Residential Care". Psychological Reports 86, nr 1 (luty 2000): 21–24. http://dx.doi.org/10.2466/pr0.2000.86.1.21.
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This article provides an overview of the Department of Veterans Affairs Community Residential Care Program and summarizes key literature about programs developed in the United States Descriptive data for 1995 and 1996 are provided to assist program planners in comparing and contrasting client characteristics and services. The authors conclude that, in addition to being cost effective, the residential care program strengthens relationships between the health care facility and the community it serves.
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Iheanacho, MD, Theddeus, Elina Stefanovics, PhD i Robert Rosenheck, MD. "Opioid use disorder and homelessness in the Veterans Health Administration: The challenge of multimorbidity". Journal of Opioid Management 14, nr 3 (2.07.2018): 171–82. http://dx.doi.org/10.5055/jom.2018.0447.
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Objective: The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA).Design: Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD.Results: Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent).Conclusions: OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.
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Bail, Jennifer, Ajitha Kommalapati, John Dell'Italia i Devika Govind Das. "National lung cancer screening rates among women veterans within the Veterans’ Health Administration." Journal of Clinical Oncology 41, nr 16_suppl (1.06.2023): 1543. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.1543.
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1543 Background: Lung cancer is the number one cause of cancer related death among women in the United States. United States Preventive Services Task Force (USPTF) lung cancer screening (LCS) guidelines recommend annual low dose computed tomography (LDCT) among high-risk populations. The data specifically on women veterans is sparse so we retrospectively examined LCS rates among women veterans within the VHA. Methods: Women veterans ages 50-80, current or former (quit within 15 years) smokers from 2013- 2021 were identified through the VA corporate data warehouse (CDW). Captured characteristics included: demographics, smoking history, and cancer screening history (lung, breast, cervical). Data was analyzed using R Studio software. Results: Women veterans with a history of smoking (n=40,299) tended to be aged ≥60, white (66%), single (69%), unemployed (64%), urban dwelling (67%), and residing in Southeast U.S. (31%). Overall, cancer screening rates among women veterans was low (9% lung; 27% breast; 21% cervical). Of the women not screened for lung cancer (91%; n=36,837), 11% (n=4, 016) had a personal history of cancer. While pack-year history was not documented for the vast majority (92%), 7% (n= 2, 729) reported a >30 pack-year smoking history (guideline at the time). Of these >30 pack-year smokers, 88% (n=2,418) were not screened for lung cancer. Other significant demographic predictors of increased LCS rates included Southeast Veterans Integrated Service Network (VISN region) and comorbidities such as bipolar disorder and diabetes likely due to increased exposure to healthcare. Conclusions: LCS rates, as well as breast and cervical, among women veterans within the VHA is low. The lack of documented pack-year history among women veterans with a history of smoking is concerning. Increased documentation of pack-year history may aid in identifying women for LCS. Efforts are ongoing nationally to implement an equitable centralized LCS program for all veterans and as part of that effort the Birmingham VA Health Care System has utilized their Lung precision Oncology program (LPOP) funding to pilot a structured lung cancer screening program within our Women’s Health Clinic in 2022.
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Paris, Bonnie L., i Denise M. Hynes. "Diffusion, implementation, and use of Research Electronic Data Capture (REDCap) in the Veterans Health Administration (VA)". JAMIA Open 2, nr 3 (11.06.2019): 312–16. http://dx.doi.org/10.1093/jamiaopen/ooz017.
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Abstract This case study describes the implementation of the Research Electronic Data Capture (REDCap) software at the United States Department of Veterans Affairs Veterans Health Administration (VA). VA REDCap enables secure and standardized data collection, fosters collaboration with external researchers through use of a widely used data management tool, facilitates multisite studies through use of data forms that can be shared across sites within and outside the VA, is well suited to health services research studies and quality improvement projects, and enables exporting data for analysis in the VA secure computing environment. Using a diffusion of innovation framework approach, authors explore organizational factors that shaped adoption of REDCap technology and constraints on its use within the VA. Lessons learned from the VA experience are discussed.
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Day, T. Eugene, Ajit N. Babu, Steven M. Kymes i Nathan Ravi. "Discrete Event Simulation and Real Time Locating Systems". International Journal of E-Adoption 4, nr 4 (październik 2012): 16–28. http://dx.doi.org/10.4018/jea.2012100102.
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The Veteran’s Health Administration (VHA) is the largest integrated health care system in the United States, forming the arm of the Department of Veterans Affairs (VA) that delivers medical services. From a troubled past, the VHA today is regarded as a model for healthcare transformation. The VA has evaluated and adopted a variety of cutting-edge approaches to foster greater efficiency and effectiveness in healthcare delivery as part of their systems redesign initiative. This paper discusses the integration of two health care analysis platforms: Discrete Event Simulation (DES), and Real Time Locating systems (RTLS) presenting examples of work done at the St. Louis VA Medical Center. Use of RTLS data for generation and validation of DES models is detailed, with prescriptive discussion of methodologies. The authors recommend the careful consideration of these relatively new approaches which show promise in assisting systems redesign initiatives across the health care spectrum.
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Terry, Hannah, Erica Frazier, Tamara Adler i Derek Yates. "Evaluation of provider satisfaction with mental health clinical pharmacy specialists in outpatient mental health clinics". Mental Health Clinician 10, nr 3 (1.05.2020): 76–79. http://dx.doi.org/10.9740/mhc.2020.05.076.
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Abstract Introduction Mental health services are an area of high need in many health care systems in the United States. With a limited number of psychiatric providers and a projected increase in the deficit of psychiatrists, a call for increased mental health services is apparent. The inclusion of mental health clinical pharmacy specialists (MH-CPS) as part of interdisciplinary care teams has enabled the William S. Middleton Memorial Veterans Hospital & Clinics as well as numerous other Veterans Affairs sites to improve access to mental health providers when pharmacists serve as an integral part of the mental health team. Our objectives were to (1) evaluate impressions of nonpharmacist mental health providers of MH-CPS and (2) assess for areas of improvement in MH-CPS services. Methods A survey was formulated, using 5-point Likert scale criteria, to evaluate impressions of MH-CPS from other mental health providers. Questions were designed to address impressions of clinical skills, knowledge, team contribution, and comfort with MH-CPS providers. These were distributed and completed in December 2018 by members of mental health treatment teams at the William S. Middleton Memorial Veterans Hospital & Clinics. Results Overall, mental health team members rated satisfaction with MH-CPS highly across all evaluated criteria. Discussion Per review of these results, MH-CPS are a valued and respected part of the mental health team.
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Lee, Alexander J., i Lucas S. LaFreniere. "Addressing Attrition from Psychotherapy for PTSD in the U.S. Department of Veterans Affairs". Trauma Care 3, nr 4 (8.11.2023): 274–93. http://dx.doi.org/10.3390/traumacare3040024.
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The United States Department of Veterans Affairs (VA) uses a systematized approach for disseminating evidence-based, trauma-focused psychotherapies for post-traumatic stress disorder (PTSD). Within this approach, veterans with PTSD must often choose between Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), each delivered in their standard protocols. Many veterans have been greatly helped by this approach. Yet limiting trauma-focused therapy to these two options leaves the VA unable to fully address the needs of a variety of veterans. This limitation, among other factors, contributes to the suboptimal attrition rates within the VA. The present review proposes solutions to address treatment barriers that are both practical (such as time and travel constraints) and psychological (such as resistance to trauma exposure). By reducing barriers, attrition may lessen. Proposed countermeasures against practical barriers include intensive protocols, shortened sessions, telehealth, smartphone application delivery, or any combination of these methods. Countermeasures against psychological barriers include alternative evidence-based treatment programs (such as Acceptance and Commitment Therapy), intensive protocols for exposure-based treatments, and the integration of components from complementary treatments to facilitate PE and CPT (such as Motivational Interviewing or family therapy). By further tailoring treatment to veterans’ diverse needs, these additions may reduce attrition in VA services for PTSD.
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Sokolov, Barbara Berglund, i John Bertland. "Letterman General Hospital during World War I". California History 97, nr 3 (1.08.2020): 86–121. http://dx.doi.org/10.1525/ch.2020.97.3.86.
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When the United States entered World War I on April 6, 1917, the Army Medical Department operated only four general hospitals and was in many ways unprepared for the scale and nature of the conflict ahead. This article examines the war's impact on Letterman General Hospital in San Francisco, which was the largest of the four hospitals before the war. In addition to tripling in capacity, Letterman incorporated many of the Medical Department's new services, the most significant concerning orthopedics and physical rehabilitation. The army's embrace of the ethic of rehabilitation was part of a major change in how the government managed care and compensation for those wounded in war—a change that marked a shift, continuing to this day, in how both state and society understand the relationship between disability and citizenship. After the war, Letterman incorporated new requirements for treating veterans in support of the country's evolving veterans’ health care system, which at times was unable to provide the full level of care the government had pledged and that many veterans had come to expect.
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Dunn, Andrew S., Bart N. Green i Scott Gilford. "An Analysis of the Integration of Chiropractic Services Within the United States Military and Veterans' Health Care Systems". Journal of Manipulative and Physiological Therapeutics 32, nr 9 (listopad 2009): 749–57. http://dx.doi.org/10.1016/j.jmpt.2009.10.009.
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Ward, Carol J., Curtis Child, Bret L. Hicken, S. Matthew Stearmer, Michael R. Cope, Scott R. Sanders i Jorden E. Jackson. "“We Got an Invite into the Fortress”: VA-Community Partnerships for Meeting Veterans’ Healthcare Needs". International Journal of Environmental Research and Public Health 18, nr 16 (6.08.2021): 8334. http://dx.doi.org/10.3390/ijerph18168334.
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Responding to identified needs for increased veterans’ access to healthcare, in 2010 the United States Department of Veterans Affairs (VA) launched the Veteran Community Partnership (VCP) initiative to “foster seamless access to, and transitions among, the full continuum of non-institutional extended care and support services in VA and the community”. This initiative represents an important effort by VA to promote collaboration with a broad range of community organizations as equal partners in the service of veteran needs. The purpose of the study is an initial assessment of the VCP program. Focus group interviews conducted in six sites in 2015 included 53 representatives of the local VA and community organizations involved with rural and urban VCPs across the US. Interview topics included the experiences and practices of VCP members, perceived benefits and challenges, and the characteristics and dynamics of rural and urban areas served by VCPs. Using a community-oriented conceptual framework, the analyses address VCP processes and preliminary outcomes, including VCP goals and activities, and VCP members’ perceptions of their efforts, benefits, challenges, and achievements. The results indicate largely positive perceptions of the VCP initiative and its early outcomes by both community and VA participants. Benefits and challenges vary by rural-urban community context and include resource limitations and the potential for VA dominance of other VCP partners. Although all VCPs identified significant benefits and challenges, time and resource constraints and local organizational dynamics varied by rural and urban context. Significant investments in VCPs will be required to increase their impacts.
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Suntai, Zainab, i Kirsten Laha-Walsh. "Social Isolation Among Older Military Veterans". Innovation in Aging 5, Supplement_1 (1.12.2021): 537–38. http://dx.doi.org/10.1093/geroni/igab046.2069.
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Abstract Social isolation is an increasingly critical issue among older adults and has been found to affect several domains of well-being, including physical, psychological, and cognitive health. Research has found that military veterans often experience hardships in the transition back to civilian life including emotional trauma, depression, substance misuse and pain from combat-related injuries, which have been shown to persist well into older adulthood. As such, this study aimed to examine the prevalence of social isolation among older military veterans and determine which veterans are most at-risk of experiencing social isolation, using the Berkman-Syme Social Network Index as a framework. Data were derived from Round 1 of the National Health and Aging Trends Study (NHATS), an annual longitudinal panel survey of adults aged 65 and older living in the United States. Results showed that about 4.5% of veterans in the NHATS are severely socially isolated while another 20.9% are socially isolated. After controlling for other explanatory variables, being White, being 85 and older, having lower educational attainment, being unmarried/unpartnered and having lower income were associated with an increased risk of experiencing social isolation. Interventions aiming to improve the well-being of older veterans should consider employing both preventative and amendatory measures. These may include the creation and administration of a standardized social isolation scale during visits to veterans’ affairs (VA) medical centers and a general effort to address stressors from military service by destigmatizing and improving access to mental health services.
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Salgado, Teresa M., Meagen M. Rosenthal, Antoinette B. Coe, Tana N. Kaefer, Dave L. Dixon i Karen B. Farris. "Primary healthcare policy and vision for community pharmacy and pharmacists in the United States". Pharmacy Practice 18, nr 3 (18.09.2020): 2160. http://dx.doi.org/10.18549/pharmpract.2020.3.2160.
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The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.
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Iverson, Katherine M., Sara B. Danitz, Stephanie K. Low, Jennifer A. Knetig, Kathryn W. Doyle i LeAnn E. Bruce. "Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE): Initial Evaluation of the Clinical Effects of RISE Administered in Routine Care in the US Veterans Health Administration". International Journal of Environmental Research and Public Health 19, nr 14 (20.07.2022): 8793. http://dx.doi.org/10.3390/ijerph19148793.
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Intimate partner violence (IPV) is a common concern among military Veterans that negatively impacts health. The United States’ Veterans Health Administration (VHA) has launched a national IPV Assistance Program (IPVAP) to provide comprehensive services to Veterans, their families and caregivers, and VHA employees who use or experience IPV. Grounded in a holistic, Veteran-centered psychosocial rehabilitation framework that guides all facets of the program, the IPVAP initiated the pilot implementation of a novel intervention called Recovering from IPV through Strengths and Empowerment (RISE). This evidence-based, person-centered, trauma-informed, and empowerment-oriented brief counseling intervention is designed to support those who experience IPV and to improve their psychosocial wellbeing. This program evaluation study describes clinical outcomes from patients who participated in a pilot implementation of RISE in routine care. We examined changes in general self-efficacy, depression, and valued living, as well as treatment satisfaction among patients who received RISE and completed program evaluation measures at VHA facilities during the pilot. Results from 45 patients (84% women) indicate that RISE was associated with significant pretreatment to posttreatment improvements in self-efficacy, depression, and valued living (Cohen’s d s of 0.97, 1.09, and 0.51, respectively). Patients reported high satisfaction with treatment. Though preliminary results were similar across gender and IPV types, findings from the evaluation of the pilot implementation of RISE demonstrate the intervention’s feasibility, acceptability, and clinical utility in routine VHA care and inform the scalability of RISE. Additionally, findings provide preliminary support for the effectiveness and acceptability of RISE with men. Modification to RISE and its implementation are discussed, which may be useful to other settings implementing IPV interventions.
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Grgas, Marina. "Clinical psychiatric pharmacist involvement in an outpatient buprenorphine program". Mental Health Clinician 3, nr 6 (1.12.2013): 290–91. http://dx.doi.org/10.9740/mhc.n183353.
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Background: Approximately nineteen million individuals in the United States are diagnosed with a substance use disorder (SUD), including many veterans enrolled in the Veterans Health Administration (VHA). The prevalence of SUD within the veteran population has been steadily increasing, resulting in increased utilization of substance abuse services, such as buprenorphine programs for opioid dependence. As this population grows, there is an increased need for multidisciplinary services. Clinical psychiatric pharmacists do not have prescriptive authority for buprenorphine, but can play a vital role in outpatient buprenorphine programs. Description of Innovative Service: The clinical psychiatric pharmacist is involved in many aspects of the outpatient buprenorphine program. There are over 100 patients enrolled in the buprenorphine program at the White River Junction Veterans Affairs Medical Center (WRJVAMC). The clinical pharmacist devotes approximately ten hours per week to the program, which includes dispensing the medication, monitoring lab values, patient counseling and random medication counts. A spreadsheet is maintained and updated weekly to monitor doses, refill dates and urine toxicology results. The clinical pharmacist is also involved in the dispensing process in the outpatient pharmacy; this allows for open communication between the clinical pharmacist and patient. Impact on Patient Care: The clinical psychiatric pharmacist has been involved in the outpatient buprenorphine program at the WRJVAMC for approximately two years. Prior to this, the program included less than 100 patients, pharmacy wait times were over sixty minutes and early refills were frequent. Since clinical pharmacy involvement, the pharmacy wait time is approximately 30 minutes or less and early refills are infrequent. Patient satisfaction has also significantly improved. The clinical pharmacist has helped open the lines of communication between the patient, the pharmacy and the prescriber. Conclusion: Substance use disorder programs, such as buprenorphine programs, can benefit from clinical pharmacy involvement. Even with limited prescriptive authority, clinical psychiatric pharmacists can play an important and active role in outpatient buprenorphine programs.
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Cusack, Meagan, Allyson Varley i Ann Elizabeth Montgomery. "Applying Implementation Science Methods to Address Barriers to Employment Services Offered through the United States Department of Veterans Affairs Health Care for Homeless Veterans Program". Journal of Veterans Studies 8, nr 1 (2022): 255–65. http://dx.doi.org/10.21061/jvs.v8i1.313.
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Lee, Michelle Hyunju, Jennifer La, Mary T. Brophy, Nhan V. Do, Camille V. Edwards, Clark Dumontier, Gabriela S. Hobbs i Nathanael R. Fillmore. "Psychiatric and Substance Use Disorders Are Independent Predictors of Treatment Response and Outcomes in United States Veterans with Newly Diagnosed Acute Myeloid Leukemia Treated with Venetoclax Combinations". Blood 142, Supplement 1 (28.11.2023): 388. http://dx.doi.org/10.1182/blood-2023-180915.
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BACKGROUND: Venetoclax (VEN) combinations have become the standard frontline therapy for patients with newly diagnosed acute myeloid leukemia (AML) who are deemed unable to tolerate intensive induction chemotherapy, either due to age or comorbidities. However, outcomes in the real-world setting have been inferior to those observed in clinical trials. Preexisting psychiatric diagnoses and substance use disorders (SUDs) have previously been associated with increased mortality in patients with cancer, but their prognostic influence in veterans with AML is unclear. The aim of this study was to measure the prevalence of psychiatric and SUDs in veterans with AML treated with VEN combinations, determining the impact of these conditions on treatment response and outcomes. METHODS: This was a retrospective cohort study of veterans with newly diagnosed AML who received frontline therapy with VEN combinations within the national Veterans Affairs (VA) Healthcare System. To measure the prevalence of psychiatric and SUDs, we used the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse algorithm, which tracks health conditions by administrative claims data with International Classification of Diseases (ICD) diagnostic and procedural codes. Our endpoints were rates of complete remission or complete remission with incomplete marrow recovery (CR/CRi), early mortality (EM, or death within 60 days of treatment initiation), intensive care unit (ICU) admissions, and overall survival (OS). We evaluated the relationship between comorbid medical conditions and outcomes using Kaplan-Meier analysis and Cox proportional hazards regression models, first unadjusted, and then adjusted for all covariates. Patients who underwent allogeneic stem cell transplantation (HSCT) were excluded from statistical analyses. RESULTS: We identified 452 veterans treated with VEN up to April 1, 2022 (Table 1). In combination with VEN, 60% (n=270) received azacitadine, 37% (n=168) received decitabine, and 3% (n=14) received low-dose cytarabine. Median age was 74.3 years (IQR: 71.2-78.5) with 52% ≥75 years. By European LeukemiaNet (ELN) 2017 risk classification, 61% (n=274) were classified as adverse risk. Forty-six percent (n=206) of veterans had a preexisting psychiatric diagnosis, and 19% (n=84) had SUDs; 11% (n=49) had both comorbidities. Psychiatric disorders were significantly more prevalent in younger veterans (68% in <65 years vs 50% in 65-74 years vs 39% in ≥75 years, p<0.003); same was true for SUDs (38% in <65 years vs 26% in 65-74 years vs 9% in ≥75 years, p<0.001). For the entire cohort, CR/CRi was achieved by 57% (n=257), and only 3% (n=12) received HSCT. Zero veterans with SUDs and 8 with psychiatric diagnoses were transplanted. At the end of study period, 69% (n=310) had died. Median OS was 216 days (95% CI: 195-254). The 60-day mortality rate was 20% (n=87), of which 8 veterans had primary refractory AML. ICU admissions after treatment initiation was significantly higher in veterans with SUDs compared to those without history of SUDs (5.0 versus 2.2 per 5 person-years, p<0.001). On multivariable analyses (Table 2), both psychiatric and SUDs were independently associated with decreased odds of CR/CRi. Veterans with psychiatric disturbances had a 1.97 times higher hazard of EM (95% CI: 1.16-3.39, p=0.01) and a 1.28 times higher hazard of death (95% CI: 1.00-1.64, p=0.05) compared to veterans without concurrent psychiatric disorders. CONCLUSION: Psychiatric diagnoses and SUDs were not only prevalent among veterans with AML, but they also negatively impacted treatment response, EM, and OS-independently of age, sociodemographic variables, markers of disease risk, and VEN combination. Veterans with SUDs also had significantly higher ICU admissions after treatment initiation for AML. Compared to published clinical trials data, veterans experienced inferior outcomes. Veterans with psychiatric and SUDs may have difficulty adhering to regimens, reemergence of their mental instability and illness that is triggered by AML diagnosis and its treatment, or biologic mechanisms associated with these comorbidities. Better understanding of these factors contributing to health disparities and targeting these comorbidities with supportive care interventions alongside AML-specific therapy may improve outcomes and warrant further study.
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Baser, Onur, Elyse Fritschel, Lu Li, J. Zhang i Li Wang. "An overview of clinical and economic outcomes of U.S. veteran colorectal cancer patients." Journal of Clinical Oncology 31, nr 15_suppl (20.05.2013): e14689-e14689. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e14689.
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e14689 Background: Colorectal cancer is the second leading cause of cancer-related death in the United States. While studies have shown that conditions such as diabetes are associated with shorter disease-free survival in colon cancer patients, fewer U.S. Department of Veterans Affairs (VA)-specific studies have been conducted focusing on colorectal cancer outcomes (Centers for Disease Control and Prevention. Colorectal (colon) cancer. www.cdc.gov/cancer/colorectal. Extermann M. Interaction between comorbidity and cancer. Cancer Control. 2007; 14(1): 13-22). This study aimed to describe the comorbidity profile and economic outcomes of colorectal cancer patients in the VA population. Methods: A retrospective study of patients diagnosed with colorectal cancer during the study period of October 1, 2005 to September 30, 2010 was conducted using the Veterans Health Administration datasets. All colorectal cancer patients were identified using International Classification of Disease 9thRevision Clinical Modification (ICD-9-CM) diagnosis codes 153.xx and 154.xx. Descriptive statistics were calculated as means ± standard deviation (SD) and percentages using SAS version 9.3 software. Results: In diagnosed colorectal cancer patients (n=62,200), common comorbidities included hypertension (n=18,309, 29.44%) and diabetes (n=10,891, 17.51%). Other minor comorbidities included hyperlipidemia and benign neoplasm of the colon. The average Fecal Occult Blood Test result (found in 12.21% of colorectal cancer veterans) was 96.37. Outpatient services were utilized by 99.71% of colorectal cancer patients, followed by pharmacy (91.94%) and inpatient visits (31.15%). Costs for outpatient ($10,637, SD=$17,125), pharmacy ($2,704, SD=$9,773), and inpatient services ($16,032, SD=$53,078) contributed to follow-up health care expenditures. Conclusions: Despite frequent outpatient utilization, inpatient costs have the greatest impact on the considerable health care cost incurred by lung cancer veterans. The presence of comorbid conditions may further complicate colorectal cancer treatment, though further characterization requires further research.
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Stal, Julia, Kimberly A. Miller, Timothy W. Mullett, Judy C. Boughey, Amanda B. Francescatti, Elizabeth Funk, Heidi Nelson i David R. Freyer. "Cancer Survivorship Care in the United States at Facilities Accredited by the Commission on Cancer". JAMA Network Open 7, nr 7 (3.07.2024): e2418736. http://dx.doi.org/10.1001/jamanetworkopen.2024.18736.
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ImportanceSince 2021, American College of Surgeons Commission on Cancer (CoC) accreditation standards require providing a survivorship program for patients with adult-onset cancer treated with curative intent. Since more than 70% of all patients with cancer in the US are treated at CoC-accredited facilities, this presents an opportunity for a landscape analysis of survivorship care availability.ObjectiveTo determine the prevalence, types, and outcomes of cancer survivorship services at CoC-accredited facilities.Design, Setting, and ParticipantsThis survey study used an anonymous, online, cross-sectional survey conducted from May 4 to 25, 2023. Participants were CoC-accredited facilities in the US representing diverse CoC program categories, institutional characteristics, geographic regions, and practice types. Department of Veterans Affairs cancer programs were excluded due to data usage restrictions. Data were analyzed from July to October 2023.ExposureCoC Survivorship Standard 4.8 was released in October 2019 and programs were expected to adhere to the Standard beginning January 1, 2021.Main Outcomes and MeasuresQuestions included self-reported survivorship program characteristics, availability of services aligned to CoC Survivorship Standard 4.8, and perceived program impacts. Response frequencies and proportions were determined in aggregate and by CoC program category.ResultsThere were 1400 eligible programs, and 384 programs participated (27.4% response rate). All regions and eligible program categories were represented, and most had analytic caseloads of 500 to 4999 patients in 2021. Most survivorship program personnel included nurses (334 programs [87.0%]) and social workers (278 programs [72.4%]), while physical (180 programs [46.9%]) and occupational (87 programs [22.7%]) therapists were less common. Services most endorsed as available for all survivors were screening for new cancers (330 programs [87.5%]), nutritional counseling (325 programs [85.3%]), and referrals to specialists (320 programs [84.7%]), while treatment summaries (242 programs [64.7%]), and survivorship care plans (173 programs [43.0%]), sexual health (217 programs [57.3%]), and fertility (214 programs [56.9%]) were less common. Survivorship services were usually delivered by cancer treatment teams (243 programs [63.3%]) rather than specialized survivorship clinics (120 programs [31.3%]). For resources needed, additional advanced practice clinicians with dedicated survivorship effort (205 programs [53.4%]) and electronic health record enhancements (185 programs [48.2%]) were most endorsed. Lack of referrals and low patient awareness were endorsed as the primary barriers. A total of 335 programs (87.2%) agreed that Survivorship Standard 4.8 helped advance their programs.Conclusions and RelevanceThese findings of this survey study of CoC-accredited programs establish a benchmark for survivorship care delivery in the US, identify gaps in specific services and opportunities for intervention, contribute to longitudinal reevaluation for tracking progress nationally, and suggest the value of survivorship care standards.
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Mason, Anne, Michael Drummond, Scott Ramsey, Jonathan Campbell i Dennis Raisch. "Comparison of Anticancer Drug Coverage Decisions in the United States and United Kingdom: Does the Evidence Support the Rhetoric?" Journal of Clinical Oncology 28, nr 20 (10.07.2010): 3234–38. http://dx.doi.org/10.1200/jco.2009.26.2758.
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Purpose In contrast to the United States, several European countries have health technology assessment programs for drugs, many of which assess cost effectiveness. Coverage decisions that consider cost effectiveness may lead to restrictions in access. Methods For a purposive sample of five decision-making bodies, we analyzed US and United Kingdom coverage decisions on all anticancer drugs approved by the US Food and Drug Administration (FDA) from 2004 to 2008. Data sources for the timing and outcome of licensing and coverage decisions included published and unpublished documentation, Web sites, and personal communication. Results The FDA approved 59 anticancer drugs over the study period, of which 46 were also approved by the European Medicines Agency. In the United States, 100% of drugs were covered, mostly without restriction. However, the United Kingdom bodies made positive coverage decisions for less than half of licensed drugs (National Institute for Health and Clinical Excellence [NICE]: 39%; Scottish Medicines Consortium [SMC]: 43%). Whereas the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs (VA) covered all 59 drugs from the FDA license date, delays were evident for some Regence Group decisions that were informed by cost effectiveness (median, 0 days; semi-interquartile range [SIQR], 122 days; n = 22). Relative to the European Medicines Agency license date, median time to coverage was 783 days (SIQR, 170 days) for NICE and 231 days (SIQR, 129 days) for the SMC. Conclusion Anticancer drug coverage decisions that consider cost effectiveness are associated with greater restrictions and slower time to coverage. However, this approach may represent an explicit alternative to rationing achieved through the use of patient copayments.
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Parikh, Divya Ahuja, Jenni Chang, Lakedia Charman Banks i Manali I. Patel. "Evaluating the teleoncology experience of veterans with prostate cancer: A qualitative study." JCO Oncology Practice 19, nr 11_suppl (listopad 2023): 524. http://dx.doi.org/10.1200/op.2023.19.11_suppl.524.
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524 Background: Teleoncology programs have emerged as an innovative approach to deliver cancer care, addressing barriers such as geographical distance and limited access to specialized services. The Veterans Health Administration (VHA) which is the largest integrated healthcare system in the United States has implemented teleoncology programs, including national programs through the National Teleoncology Program and more regional programs such as VISN Clinical Resource Hub (CRH), which operates under a hub-and-spoke model. This study aims to qualitatively evaluate the experience of veterans with prostate cancer within the regional VISN CRH teleoncology program. Methods: Veterans diagnosed with prostate cancer who were receiving oncology care through the VISN CRH teleoncology program for at least 3 months were recruited for interviews. The 1:1, 30 minute interviews were conducted using a semi-structured interview guide adapted from a prior telemedicine publication. Thematic analysis identified recurring patterns, categorized information, and major themes related to the veterans’ experiences in the program. Results: We interviewed 22 veterans (age 67-89) with prostate cancer, the majority were White (N=19, 86%) and with Stage IV disease (N=21, 95%) on oral, IV and/or injectable medical therapies (N=22, 100%). Five themes emerged: 1) reduced financial burden associated with teleoncology, including decreased costs of transportation and less time away from work; 2) improved convenience, including flexibility in scheduling appointments; 3) improved communication with care providers with clear understanding of instructions and treatment plans, even promoting more active patient engagement; 4) improved access to specialty care and care that veterans otherwise would not have access to; and 5) positive experiences outweighed concerns of lack of face-to-face contact. Conclusions: This qualitative study provides valuable insights into the teleoncology experience of veterans with prostate cancer. The veterans in this study describe reduced financial burden, increased engagement and improved access to subspecialty and other care. These findings highlight the importance of further evaluating the use of teleoncology programs to optimize cancer care delivery.
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Robb-Jackson, Carley, i Sandra Campbell. "‘Healthy Relationships’ campaign: Preventing and addressing family and gender-based violence". Journal of Military, Veteran and Family Health 8, nr 1 (1.02.2022): 125–30. http://dx.doi.org/10.3138/jmvfh-2021-0014.
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LAY SUMMARY Canadian military families face distinct challenges due to the military lifestyle, primarily due to relocation, absences and deployments, and risk of injury and death. Tied to these challenges is the intimate partner relationship and the ability of the family unit to thrive. To support families, Military Family Services (MFS) undertook a collaborative process to create a modernized campaign focused on healthy relationships for Canadian Armed Forces (CAF) members, Veterans, and their families. The “Healthy Relationships” campaign is a unique social media campaign centred on positive behaviour change, inspiration, and sharing of real military families’ stories. The campaign sought to shift the narrative from previous anti-family-violence messaging to promoting positive, healthy, and equitable relationships. The campaign was successful in its rollout across bases and wings in Canada, Europe, and the United States.
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McCord, Sarah A., Mary G. Lynch i April Y. Maa. "Diagnosis of retinal detachments by a tele-ophthalmology screening program". Journal of Telemedicine and Telecare 25, nr 3 (28.02.2018): 190–92. http://dx.doi.org/10.1177/1357633x18760418.
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In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.
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Tsai, Jack, Julia M. Whealin i Robert H. Pietrzak. "Asian American and Pacific Islander Military Veterans in the United States: Health Service Use and Perceived Barriers to Mental Health Services". American Journal of Public Health 104, S4 (wrzesień 2014): S538—S547. http://dx.doi.org/10.2105/ajph.2014.302124.
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May, Anna, Lu Wang i Mendel Singer. "453 Cost-Effectiveness of Requalifying for Positive Airway Pressure Treatment After Initial Nonadherence". Sleep 44, Supplement_2 (1.05.2021): A179. http://dx.doi.org/10.1093/sleep/zsab072.452.
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Abstract Introduction Obstructive sleep apnea (OSA) is effectively treated with continuous positive airway pressure (CPAP). However, many people are not able to become adherent in the initial 90-day trial window for this therapy. Medicare requires a polysomnography and repeat trial documenting adherence before continuing payment for these services. Oral appliance therapy (OAT) is also an OSA first-line therapy but is less effective than CPAP. Methods We created a decision tree to model 4 strategies over a 5-year time horizon: (1) current policy, (2) direct referral for CPAP equipment, (3) OAT followed by CPAP under current policy, and (4) OAT followed by direct CPAP referral in a the Medicare population with mild-moderate OSA and nonadherence to a first attempt at CPAP therapy. Medicare fee schedules in 2020 defined costs. Incremental cost-effectiveness (ICER) was used to identify the supreme strategy Results The current policy was the most expensive. Both the current policy and direct DME referral were dominated by starting with OAT. OAT followed by titration was the most cost-effective strategy with an ICER of $42,586.47. The ICER was sensitive to adherence in the direct CPAP strategy and probability of getting CPAP equipment (vs. lost to follow-up). Conclusion Starting with OAT therapy in those that were CPAP nonadherent on first attempt is cost-effective. Despite decreased effectiveness, the increase adherence to OAT make it an attractive option for retrial of OSA therapy. If OAT therapy fails, the current policy is more cost-effective than direct CPAP referral. Support (if any) This study was supported Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.
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Gujral, Kritee, Nazanin Bahraini, Lisa A. Brenner, James Van Campen, Donna M. Zulman, Samantha Illarmo i Todd H. Wagner. "VA’s implementation of universal screening and evaluation for the suicide risk identification program in November 2020 –Implications for Veterans with prior mental health needs". PLOS ONE 18, nr 4 (11.04.2023): e0283633. http://dx.doi.org/10.1371/journal.pone.0283633.
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Importance United States Veterans are at higher risk for suicide than non-Veterans. Veterans in rural areas are at higher risk than their urban counterparts. The coronavirus pandemic intensified risk factors for suicide, especially in rural areas. Objective To examine associations between Veterans Health Administration’s (VA’s) universal suicide risk screening, implemented November 2020, and likelihood of Veterans being screened, and receiving follow-up evaluations, as well as post-screening suicidal behavior among patients who used VA mental health services in 2019. Methods VA’s Suicide Risk Identification Strategy (Risk ID), implemented October 2018, is a national, standardized process for suicide risk screening and evaluation. In November 2020, VA expanded Risk ID, requiring annual universal suicide screening. As such, we are evaluating outcomes of interest before and after the start of the policy among Veterans who had ≥1 VA mental health care visit in 2019 (n = 1,654,180; rural n = 485,592, urban n = 1,168,588). Regression-adjusted outcomes were compared 6 months pre-universal screening and 6, 12 and 13 months post-universal screening implementation. Measures Item-9 on the Patient Health Questionnaire (I-9, VA’s historic suicide screener), Columbia- Suicide Severity Risk Scale (C-SSRS) Screener, VA’s Comprehensive Suicide Risk Evaluation (CSRE), and Suicide Behavior and Overdose Report (SBOR). Results 12 months post-universal screening implementation, 1.3 million Veterans (80% of the study cohort) were screened or evaluated for suicide risk, with 91% the sub-cohort who had at least one mental health visit in the 12 months post-universal screening implementation period were screened or evaluated. At least 20% of the study cohort was screened outside of mental health care settings. Among Veterans with positive screens, 80% received follow-up CSREs. Covariate-adjusted models indicated that an additional 89,160 Veterans were screened per month via the C-SSRS and an additional 30,106 Veterans/month screened via either C-SSRS or I-9 post-universal screening implementation. Compared to their urban counterparts, 7,720 additional rural Veterans/month were screened via the C-SSRS and 9,226 additional rural Veterans/month were screened via either the C-SSRS or I-9. Conclusion VA’s universal screening requirement via VA’s Risk ID program increased screening for suicide risk among Veterans with mental health care needs. A universal approach to screening may be particularly advantageous for rural Veterans, who are typically at higher risk for suicide but have fewer interactions with the health care system, particularly within specialty care settings, due to higher barriers to accessing care. Insights from this program offer valuable insights for health systems nationwide.
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Yu, Wei, Arliene Ravelo, Todd H. Wagner, Ciaran S. Phibbs, Aman Bhandari, Shuo Chen i Paul G. Barnett. "Prevalence and Costs of Chronic Conditions in the VA Health Care System". Medical Care Research and Review 60, nr 3_suppl (wrzesień 2003): 146S—167S. http://dx.doi.org/10.1177/1077558703257000.
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Chronic conditions are among the most common causes of death and disability in the United States. Patients with such conditions receive disproportionate amounts of health care services and therefore cost more per capita than the average patient. This study assesses the prevalence among the Department of Veterans Affairs (VA) health care users and VA expenditures (costs) of 29 common chronic conditions. The authors used regression to identify the marginal impact of these conditions on total, inpatient, outpatient, and pharmacy costs. Excluding costs of contracted medical services at non-VA facilities, total VA health care expenditures in fiscal year 1999 (FY1999) were $14.3 billion. Among the 3.4 million VA patients in FY1999, 72 percent had 1 or more of the 29 chronic conditions, and these patients accounted for 96 percent of the total costs ($13.7 billion). In addition, 35 percent (1.2 million) of VA health care users had 3 or more of the 29 chronic conditions. These individuals accounted for 73 percent of the total cost. Overall, VA health care users have more chronic diseases than the general population.
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Kelley, Rosalie J., Tina M. Waliczek i F. Alice Le Duc. "The Effects of Greenhouse Activities on Psychological Stress, Depression, and Anxiety among University Students Who Served in the U.S. Armed Forces". HortScience 52, nr 12 (grudzień 2017): 1834–39. http://dx.doi.org/10.21273/hortsci12372-17.
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The mental health of the men and women who served in the U.S. Armed Forces is an area of great concern in the United States. Studies have shown the mental health of university students is also a concern with a growing need for support services and prevention measures. The main objective of this study was to determine the effects of participation in particular greenhouse activities on depression, anxiety, and stress levels of students who served in the U.S. Armed Forces. The study included a control group and a treatment group. Participants completed a pre- and post 21-item Depression Anxiety and Stress Scale (DASS-21) survey, along with a questionnaire designed to capture participants’ demographic information and information regarding their military service history. The treatment consisted of a 6-week indoor plant care program. Results of the study found that student veterans who participated in the plant care class had decreased levels of depression and stress when compared with the control group. In the post-test open-ended questions, student veterans described a noticeable feeling of reduced stress along with the ability to relax while having feelings of a sense of place (belonging). Participants also indicated that they would continue to grow plants as a hobby.
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Iyer, Sowmya, Victoria Ngo, Marika Humber, Marisa Brodrick, Christine Gould i Ranak Trivedi. "DEMENTIA CAREGIVER PERCEPTIONS OF TELE-DEMENTIA CARE FOR VETERANS DURING THE COVID-19 PANDEMIC". Innovation in Aging 6, Supplement_1 (1.11.2022): 554. http://dx.doi.org/10.1093/geroni/igac059.2096.
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Abstract The estimated 5 million persons living with dementia in the United States have been greatly impacted by the medical and psychosocial impacts of the COVID-19 pandemic, respite program closures, social isolation, and Veterans seen within the Veterans Health Administration system are particularly vulnerable. Telemedicine provides needed specialty dementia care to these patients with complex needs in their homes, and its uptake has increased during the pandemic. This qualitative, observational study explored informal caregivers’ perceptions of tele-dementia care for Veterans seen at 2 sites, Palo Alto and Cleveland, via semi-structured interviews. Twenty-five caregivers (Mean age = 67y, SD=12y, 88% women) were interviewed over telephone following a tele-dementia visit. Themes that emerged from the interviews were that tele-dementia visits: (1) saved caregivers 2.6h±1.5h (Range: 0.5 to 6h) of travel time, (2) required limited preparation compared to in-person visits, (3) mitigated COVID-19 risk and avoided needs for masking and social distancing, (4) avoided behavioral challenges during appointments, and (5) allowed participation from home with minimal disruption of routine. Caregivers described significant physical challenges that made leaving the home for appointments difficult including balance issues, incontinence, and difficulties getting into vehicle. Caregivers plan to continue using tele-dementia services beyond the pandemic due to the convenience. Taken together, these findings indicate that caregivers find tele-dementia care convenient, comfortable, helpful, and timesaving and highly satisfactory. A combination of both in-person and virtual visits would be an ideal future state. This study illustrates how caregivers experience virtual visits for dementia care and will shape future intervention design.