Care for Women Veterans with Hepatitis C Virus Infection

照顾感染丙型肝炎病毒的女性退伍军人

• 批准号: 8596038
• 负责人: FASIHA KANWAL
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8596038
• 关键词: Accounting; Address; Adverse effects; Alcohols; Antiviral Agents; Anxiety; Benchmarking; Caring; Characteristics; Chronic; Chronic Care; Chronic Hepatitis C; Clinic; Collaborations; Comorbidity; Complement; Data; Development; Drug usage; Enrollment; Evaluation; Gender; Goals; HIV; Health; Health Personnel; Health Services Accessibility; Healthcare; Hepatitis C; Improve Access; Intervention; Interview; Knowledge; Life; Liver diseases; Measures; Medicaid; Mental Depression; Mental Health; Mental disorders; Methods; Military Personnel; Organizational Policy; Patient Self-Report; Patients; Perception; Population; Post-Traumatic Stress Disorders; Primary Care Physician; Primary Health Care; Primary carcinoma of the liver cells; Quality of Care; Regression Analysis; Research; Risk; Services; Sex Characteristics; Site; Specialist; Staging; Street Drugs; Structure; Subgroup; Veterans; Woman; Women' s Group; Women' s Health; base; care seeking; cohort; design; experience; health administration; improved; insight; interest; male; medical specialties; men; patient oriented; research clinical testing; response; safety net; sexual trauma; young woman

DESCRIPTION (provided by applicant): Background - CHC treatment is associated with major gains in health, including reduced risk of progression to end-stage liver disease and hepatocellular carcinoma. Most of our knowledge of CHC care in the VHA is based on studies of men. This is a problem because women's health-care needs differ from men's for several conditions including CHC and barriers to CHC treatment are also likely to vary by gender. Women with CHC have more mental health comorbidities-the leading modifiable barrier to antiviral treatment. Women also have much higher self-reported military sexual trauma, which often leads to mental health issues. Women's care experiences and their perception of care in the VHA are also distinct from those of men. The recent increases in the proportion of women in the VHA and the availability of more effective CHC treatment necessitate a specific focus on modifiable factors that may be contributing to missed treatment opportunities in women Veterans with CHC. Objectives - The proposed project will use a mixed methods design to (1) examine gender differences in access to and receipt of CHC care measured by seeing a CHC specialist and receipt of antiviral treatment, respectively, (2) identify predictors of access to and receipt of CHC care in women Veterans with CHC, (3) characterize women's experiences with accessing CHC care and receiving CHC treatment in the VHA Methods - To achieve Aim 1, we will use existing structured automated data to examine the rate of seeing CHC specialist and receipt of antiviral treatment in a national cohort of Veterans with CHC (n>6000 women and >150,000 men) who are enrolled in the VHA during 2002-2012 to examine the effect of gender on these endpoints. To achieve Aim 2, we will conduct multi-level regression analyses to identify key predictors (especially high-impact, modifiable factors) of access to and receipt of CHC treatment among women Veterans with CHC. We will also construct separate multi-level regression in a parallel cohort of male Veterans with CHC for purposes of benchmarking. To achieve Aim 3, we will conduct a qualitative study consisting of in-depth narrative interviews with women Veterans with CHC at 3 geographically distinct VHA sites who have either, 1) not seen a CHC specialist, 2) seen a specialist once but have not completed clinical evaluation of their CHC, or 3) expressed interest in or received CHC treatment. We expect that the responses from these 3 patient groups will provide complementary insight into the factors that patients consider (or potentially should or could have considered) in engaging in CHC care as well as the perceived barriers to and facilitators of such engagement in quality care from the woman veterans' perspective.

描述（由申请人提供）： 背景 - CHC 治疗与健康的重大改善相关，包括降低进展为终末期肝病和肝细胞癌的风险。我们对 VHA 中 CHC 护理的大部分了解都是基于对男性的研究。这是一个问题，因为在包括 CHC 在内的多种疾病方面，女性的医疗保健需求与男性不同，而且 CHC 治疗的障碍也可能因性别而异。患有 CHC 的女性有更多的心理健康合并症，这是抗病毒治疗的主要可改变障碍。女性自我报告的军事性创伤也高得多，这往往会导致心理健康问题。女性的护理经历以及她们对 VHA 护理的看法也与男性不同。最近，VHA 中女性比例的增加以及更有效的 CHC 治疗的出现，需要特别关注可改变的因素，这些因素可能导致患有 CHC 的女性退伍军人错过治疗机会。目标 - 拟议项目将使用混合方法设计来 (1) 通过分别看 CHC 专家和接受抗病毒治疗来衡量获得和接受 CHC 护理的性别差异，(2) 确定获得和接受 CHC 护理的预测因素患有 CHC 的女性退伍军人中的 CHC 护理，(3) 描述女性在 VHA 方法中获得 CHC 护理和接受 CHC 治疗的经历 - 为了实现目标 1，我们将使用现有的结构化自动化数据来检查就诊 CHC 的比率在 2002 年至 2012 年期间加入 VHA 的全国患有 CHC 的退伍军人队列（n>6000 名女性和 >150,000 名男性）中接受专科医师治疗并接受抗病毒治疗，以检查性别对这些终点的影响。为了实现目标 2，我们将进行多级回归分析，以确定患有 CHC 的女性退伍军人获得和接受 CHC 治疗的关键预测因素（尤其是高影响、可修改的因素）。我们还将在具有 CHC 的男性退伍军人平行队列中构建单独的多级回归，以进行基准测试。为了实现目标 3，我们将进行一项定性研究，其中包括对 3 个不同地理位置的 VHA 站点的患有 CHC 的女性退伍军人进行深入的叙述性访谈，这些退伍军人要么 1) 没有看过 CHC 专家，2) 看过一次专家但从未见过专家完成了 CHC 的临床评估，或 3) 表达了对 CHC 治疗的兴趣或接受了 CHC 治疗。我们预计，这 3 个患者群体的回答将提供对患者在参与 CHC 护理时考虑（或可能应该或可能考虑）的因素的补充见解，以及参与此类优质护理的感知障碍和促进因素。女退伍军人的观点。