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  • 1. Overview of Women Veterans in the VA Greater Los Angeles Healthcare System Callie Wight MA, RN GLAHS Women Veterans Program Manager March 8, 2012 March 7, 2012 1cw.cg.eb2012

2. March 7, 2012 2cw.cg.eb2012 3. 3 Women comprise approximately: 14% of active duty military 18% of National Guard and Reserves 6% of VA health care users Operation Enduring Freedom/Operation Iraqi Freedom 48% of female OEF/OIF veterans have enrolled with VA health care, 44% of whom have used VA health care 2-10 times Increasing recognition of Women Veterans unique and complex health needsinflux of younger Women Veterans of childbearing age March 7, 2012 cw.cg.eb2012 4. Need increasing capacity Cohort: Women and men Veteran VHA users in year. Women in FY09: N=292,921; Men in FY09: N=4,846,869. Source: WHEI analysis of ADUSH Monthly Enrollment Files, FY00FY09. . 4March 7, 2012 cw.cg.eb2012 5. Influx of younger women Maternity care Mental health Service-connected disabilities Privacy, safety, convenience Older women (largest sub-population of female VA users) Menopausal needs Geriatric care Inpatient/extended stays Increasing Demand 5 3/7/12 March 7, 2012 cw.cg.eb2012 6. VA women users have heavier health burdens VA cares for a sicker women Veteran population compared to healthcare settings outside of the VA. Women Veterans have higher rates of chronic diseases, including cardiovascular diseases. 6March 7, 2012 cw.cg.eb2012 7. Age distribution among women Veteran VHA patients, FY09 7 Cohort: Women Veteran VHA users who have non-missing ages between 18 and 110 years old (inclusive) in year. N=159.548 in FY00, N=292,878 in FY09. Source: WHEI analysis of ADUSH Monthly Enrollment File, FY09.March 7, 2012 cw.cg.eb2012 8. Age group of Veteran patients, by gender, FY09 8 Cohort: Women and men Veteran VHA users who have non-missing ages between 18 and 110 years old (inclusive) in FY09. Women: N=292,894; Men: N=4,846,792. Source: WHEI analysis of ADUSH Monthly Enrollment Files, FY09. . March 7, 2012 cw.cg.eb2012 9. Service-Connected Status, FY00 vs FY09 Women Veteran VHA patients Cohort: Women Veteran VHA users with non-missing SC values in year. N=158,160 in FY00, N=292,108 in FY09. Source: WHEI analysis of ADUSH Monthly Enrollment Files, FY00 and FY09. Majority have SC rating 9March 7, 2012 cw.cg.eb2012 10. Service-Connected Status: Women vs. Men Veteran VHA patients Cohort: Women and men Veteran VHA users with non-missing SC values in FY09. Women: N=292,108; Men: N=4,838,232. Source: WHEI analysis of ADUSH Monthly Enrollment File, FY09. More women eligible for VHA care for SC conditions. 10March 7, 2012 cw.cg.eb2012 11. March 7, 2012 11cw.cg.eb2012 12. Based on 1+ instance of an ICD-9 code in FY08 Top 8 Conditions in Women Veterans -Common medical conditions amenable to intervention include cardiovascular risk factors and painful conditions -Health services delivery systems must take varying needs of different age groups into account Frayne SM. VA Womens Health Evaluation Initiative. VA HSR&D Womens Health Services Research Conference in Washington DC July, 2010. 12March 7, 2012 cw.cg.eb2012 13. # of Mental Health Visits, by Age Group, Women vs. Men (FY09) Cohort: Women and men Veteran VHA outpatients who have non-missing ages between 18 and 110 years old (inclusive) in FY09. Women: N=287,436; Men: N=4,747,995. Sources: WHEI analysis of ADUSH Monthly Enrollment File, FY09; VA outpatient utilization file (SE), FY09. Heavy use of mental health services 13March 7, 2012 cw.cg.eb2012 14. Privacy, Safety, Dignity A chaperone must be present at all gender specific exams, procedures, or treatments and when requested by a female Veteran for any visit, regardless of the gender of the provider. Whenever a woman is disrobed. The health care environment directly and indirectly affects the quality of care provided to women Veterans. It affects their comfort and sense of security, as well as their perceptions of care received. Measures must be taken to maintain and adjust care environments to support their dignity, privacy, and security. March 7, 2012 14cw.cg.eb2012 15. Homelessness & Women Veterans GAO Report (GAO 12-182) number of women veterans identified as homeless more than doubled, from 1,380 in fiscal year 2006 to 3,328 in fiscal year 2010. almost two-thirds were between 40 and 59 years old and over one-third had disabilities. many of these women resided with their minor children. Female Veterans are the fastest growing segment of the homeless population Women who are Veterans are at much higher risk of homelessness than male counterparts Source: Vasquez, S. Homelessness Among Women Veterans PowerPoint presentation; July 2011 National Summit on Women Veterans. http://www.va.gov/WOMENVET/2011Summit/ VasquezFINAL.pdf VA Homeless Programs Serve Women Veterans 24 3/7/12 March 7, 2012 cw.cg.eb2012 16. MST Among Homeless, Female VHA Users FY10 38.7 % of homeless women VHA users screen positive for MST 87.2% of homeless women VHA users had at least one MST-related Mental Health Encounter 16 Source: Vasquez, S. Homelessness Among Women Veterans PowerPoint presentation; July 2011 National Summit on Women Veterans. http://www.va.gov/WOMENVET/2011Summit/VasquezFINAL.pdf 3/7/12 March 7, 2012 cw.cg.eb2012 17. Military Sexual Trauma (MST) Defined by the Department of Veterans Affairs as: Sexual harassment that is threatening in character or Physical assault of a sexual nature Which occurred while the victim was in the military, Regardless of geographic location of the trauma, gender of victim, or the relationship to the perpetrator. And as interpreted by the veteran VACO policy is that VA clinicians address the substantial physical and mental illness that can follow MST. March 7, 2012 17cw.cg.eb2012 18. How Does Military Sexual Trauma (MST) Affect Veterans? Across a range of studies, Veterans with histories of MST report: More mental health problems (e.g., anxiety, depression and substance abuse disorders) More physical health symptoms and conditions More problems readjusting after discharge Mental and physical health conditions that can contribute to difficulties with employment (e.g., problems with concentration, difficulty sleeping, physical pain) 18 Source: Vasquez, S. Homelessness Among Women Veterans PowerPoint presentation; July 2011 National Summit on Women Veterans. http://www.va.gov/WOMENVET/2011Summit/VasquezFINAL.pdf 3/7/12 March 7, 2012 cw.cg.eb2012 19. Trauma-informed Care Trauma-informed care can include family education on how trauma impacts behavior, cognitions, and mood development of family skills to deal with memories of trauma and traumatic symptoms families are provided with tools for bonding when presented with traumatic reminders *National Task Force on Children Exposed to Violence Resources: National Child Traumatic Stress Network nctsn.org, https:// www.childwelfare.gov/responding/trauma.cfm, SAMHSA National Center for Trauma Informed Care http://www.samhsa.gov/nctic/default.asp March 7, 2012 cw.cg.eb2012 19 20. MST Among OEF/OIF Veterans No good prevalence data, but we know MST is occurring Particular issues to consider: Trauma is recent, reactions are acute Interaction between combat exposure and MST is unclear How TBI may affect treatment is unclear Issue of compounded stressors, particularly while away from home and support network DoDs new policies and programs are an improvement, but are still new/untestedMarch 7, 2012 20cw.cg.eb2012 21. 21March 7, 2012 cw.cg.eb2012 22. Childbearing age veterans Optimize control of chronic health conditions Safe prescribing education for all providers Pre-pregnancy care/screening by primary care providers for all women of childbearing age Address contraceptive options for women of childbearing age Counsel women regarding use of potential teratogenic medications Assessment of lifestyle habits such as smoking, alcohol or drug use, and sexual history 22March 7, 2012 cw.cg.eb2012 23. Pregnancy In a study of women Veterans of OEF/OIF, who were less than 50 years old, and used VA, from 2001-2008: 43,078 women returned from deployment 2,966 (7%) had a pregnancy during the time period March 7, 2012 23 Source: Mattocks, 2011, Journal of Women's Health. cw.cg.eb2012 24. Increasing VHA utilization by women Veterans Growing demand for PC and MH services 24 Berg E, Laungani K, Friedman SA, Phibbs CS, Herrera L, Hayes PM, Frayne SM. The Decade in Review: Trends in Outpatient Utilization among Women Veterans. Poster Presentation at the VA HSR&D Research Conference in Washington DC Feb, 2011 March 7, 2012 cw.cg.eb2012 25. Thanks to Laurie C. Zephyrin MD, MPH, MBA, FACOG Director, Reproductive Health,Women Veterans Health Strategic Health Care Group Susan Frayne MD, MPH Center for Health Care Evaluation, VA Palo Alto Health Care System, Associate Professor of Medicine, Stanford University Sally Haskell, MD Associate Professor of Medicine, Yale University School of Medicine, Acting Director, Comprehensive Womens Health Women Veterans Health Strategic Healthcare Group Patricia M. Hayes, Ph.D Chief Consultant, Women Veterans Health Strategic Health Care Group 25March 7, 2012 cw.cg.eb2012 26. Sources include Sourcebook: Women Veterans in the Veterans Health Administration - Volume 1 (December 2010) Frayne SM. VA Womens Health Evaluation Initiative. VA HSR&D Womens Health Services Research Conference in Washington DC July, 2010 Berg E, Laungani K, Friedman SA, Phibbs CS, Herrera L, Hayes PM, Frayne SM. The Decade in Review: Trends in Outpatient Utilization among Women Veterans. Poster Presentation at the VA HSR&D Research Conference in Washington DC Feb, 2011 26March 7, 2012 cw.cg.eb2012