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BACKGROUND/RATIONALE:
Women are one of the fastest growing segments of the veteran and VA user populations. From fiscal year 1998 to fiscal year 2003, there was a 44% increase in the number of unique women veteran VA users. Within the next five years women are projected to account for greater than 10% of VA health care users. The HSR&D study, Women Veterans Ambulatory Care Use: Patterns, Barriers, and Influences (GEN- 00-082), upon which the current study builds, revealed important barriers to meeting women veterans' chronic illness care needs.
OBJECTIVE(S):
The objectives of this study are to: (a) identify differences in disease burden and utilization of physical and/or mental health care services among women veterans by different categories of VA utilization; (b) determine the degree to which distance to VA sites and service availability mediates the relationship between health care need and VA use for women veterans by type of physical and mental health disease burden; and (c) identify determinants of gender differences in VA utilization.
METHODS:
To achieve these objectives, we are conducting statistical analyses of merged secondary data from existing data sources. The Women Veterans Ambulatory Care Use: Patterns, Barriers, and Influences dataset is providing detailed data on military experience, sociodemographic and health characteristics, ambulatory care utilization, preferences for care, and VA experiences of 2,174 women veterans residing in the southern California and southern Nevada area. VA administrative data is providing in-patient and out-patient utilization and ICD-9 codes for determination of physical and mental health co-morbidity for the subset of survey respondents who used either VA or Medicare healthcare services. The 2001 National Survey of Veterans is providing a national portrait of health care use by male and female veterans, to allow for a determination of gender differences on key measures of utilization and co-morbidity, to help place the analysis from the Women Veterans Ambulatory Care Use: Patterns, Barriers, and Influences dataset in context.
FINDINGS/RESULTS:
Women veterans in this cohort have high levels of physical and mental health disease burden, with 66.5% having one or more diagnosed medical conditions, 23.0% having diagnosed depression, 19.6% having both, and 30.1% having neither. Nineteen percent screened positive for current symptoms of depression, anxiety, or PTSD. VA health care users, compared with VA nonusers, were more likely to have diagnosed medical conditions (odds ratio [O.R.] 2.4), diagnosed depression (O.R. 3.0), or a positive mental health screen (O.R. 2.9). Eighty-seven percent of women veterans used health care services in the prior 12 months. The main health care service used varied by source of health care, with primary care and/or women's health being cited as the main services used by 55.0 % of VA users in contrast to 74.7% of VA nonusers, and mental health care services being the main service used by 13.4% of VA users and 3.1% of VA nonusers. Adjusting for differences in physical and mental health co-morbidity, VA health care users were more likely than VA nonusers to receive mental health care services in the prior 12 months (adjusted O.R. 3.7).
IMPACT:
By examining the patterns, barriers, and influences on ambulatory care use by women veterans with different levels of physical and/or mental health disease burden, the VA may better understand the physical and mental health care needs of women veterans in ways that will contribute toward identifying potential health care system gaps and approaches for enhancing VA's ability to meet these needs.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Special (Underserved, High Risk) Populations
DRE:
Resource Use and Cost
Keywords:
Access, Utilization patterns, Women - or gender differences
MeSH Terms:
none
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