Improving care for women Veterans with substance use disorders

改善对患有药物滥用障碍的女性退伍军人的护理

• 批准号: 8278266
• 负责人: Katherine JoAnn Hoggatt
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8278266
• 关键词: Address; Aftercare; Alcohol or Other Drugs use; Alcohols; Biometry; Caring; Characteristics; Clinic; Comorbidity; Data; Data Sources; Dependence; Development; Diagnosis; Disease; Drug usage; Ensure; Environment; Epidemiology; Fostering; Gender; Gender Issues; Goals; Health; Health Services Research; Healthcare; Hour; Illicit Drugs; Intervention; Knowledge; Learning; Link; Medical; Mental Health; Mental Health Services; Mentorship; Methods; Military Personnel; Mood Disorders; Outcome; Outpatients; Patient-Centered Care; Patients; Pattern; Perception; Pharmacotherapy; Play; Population; Post-Traumatic Stress Disorders; Privacy; Process; Program Evaluation; Provider; Psychotic Disorders; Qualitative Research; Reporting; Research; Research Design; Research Support; Resources; Role; Safety; Services; Structure; Subgroup; Substance Use Disorder; Surveys; System; Time; Training; Training Activity; Training and Education; Treatment outcome; Veterans; Vulnerable Populations; Woman; Women' s Health; Work; career; design; dual diagnosis; evidence base; experience; implementation science; improved; male; medical specialties; men; organizational structure; patient oriented; preference; programs; public health relevance; sexual trauma; theories; treatment program

DESCRIPTION (provided by applicant): Background: Substance use disorders (SUD)-drug use illnesses consistent with abuse or dependence of a range of substances-are common and costly mental health conditions among Veterans. Research has demonstrated that women differ from men in their patterns of SUD and in their use of services and determinants of treatment and outcomes. Although the emphasis of SUD care in the VA has been on the men who make up 96% of Veterans in SUD treatment, women Veterans represent a particularly vulnerable group with distinct needs and barriers to treatment. Women Veterans have higher rates of other psychiatric conditions, including PTSD, military sexual trauma (MST), bipolar/psychotic disorder, and mood disorders than do their male counterparts, and the occurrence of concomitant PTSD or MST requires assessing and accommodating women's needs in a private and safe SUD treatment environment. Despite VA requirements for "gender aware care", most VA providers outside of women's health clinics have little or no experience delivering services to women Veterans. Women Veterans may have difficulty in the predominantly-male VA treatment environment. Purpose: The goal of the proposed CDA project is to develop the foundational evidence needed to improve women Veterans' access to optimal, gender-sensitive SUD care. To accomplish this goal, I will examine patient, provider, and organizational factors that foster or hinder the delivery of appropriate and effective care for women Veterans using mixed methods. Methods: The proposed CDA research plan will comprise 3 separate projects. The first, a secondary analysis of linked organizational- and patient-level data, will describe the patterns and determinants of women's SUD treatment involvement (initiation, engagement, and pharmacotherapy) and patient outcomes across VA facilities. The second will include the development and administration of the first survey of the organizational structure of women Veterans' VA SUD care. The survey data will be linked to patient-level data to determine the impact of women's SUD treatment structure on women veterans' treatment involvement and patient outcomes. The third project will be an in-depth qualitative study to learn from women VA SUD patients their experiences with VA SUD care and their perceptions of treatment barriers, preferences, and needs. The proposed CDA career plan builds on my strong epidemiology and biostatistics training while ensuring education, training and mentorship in the use of VA data sources, health services research design, the theory of substance use disorder, gender issues in mental health, qualitative research, organizational survey design, and implementation science. Conclusions: Providing patient-centered, gender-sensitive care for women Veterans with SUD is a VA goal, but there are fundamental information gaps on where and how women access SUD care in the VA. Moreover, little work has been done to determine the features of care that can best address women Veterans' specific needs and treatment barriers. The proposed research will address these knowledge gaps, paving the way to subsequent target efforts to provide women Veterans optimal, gender-sensitive SUD care. PUBLIC HEALTH RELEVANCE: Efforts to deliver optimal, patient-centered care for women Veterans with substance use disorder (SUD) require information on their specific treatment needs and barriers. The proposed CDA will allow me to build a career improving the delivery of gender-sensitive SUD care to women Veterans. The planned training activities will give me experience working with VA data, developing organizational surveys, and building the capacity to conduct qualitative research. The planned research will investigate for the first time the patterns of women Veterans' SUD treatment across VA settings, medical specialties, and patient subgroups; the impact of SUD treatment on women's outcomes; the detailed structure of women's SUD care in the VA; and women's qualitative experiences of VA SUD care. This research directly addresses VA HSR&D priorities in Women's Health Research and supports the efforts of the SUD-QUERI to promote patient-centered, evidence-based specialty care.

描述（由申请人提供）： 背景：物质使用障碍（SUD）——与滥用或依赖一系列物质一致的药物使用疾病——是退伍军人中常见且代价高昂的心理健康状况。研究表明，女性在 SUD 模式、服务使用以及治疗和结果的决定因素方面与男性不同。尽管 VA 的 SUD 护理重点是男性，占 SUD 治疗退伍军人的 96%，但女性退伍军人是一个特别脆弱的群体，具有独特的需求和治疗障碍。女性退伍军人比男性退伍军人有更高的其他精神疾病发生率，包括创伤后应激障碍 (PTSD)、军事性创伤 (MST)、双向情感障碍/精神障碍和情绪障碍，并且伴随 PTSD 或 MST 的发生需要评估和满足女性的需求私密且安全的SUD治疗环境。尽管退伍军人事务部要求提供“性别意识护理”，但妇女健康诊所以外的大多数退伍军人事务提供者几乎没有或根本没有为女性退伍军人提供服务的经验。女性退伍军人在以男性为主的退伍军人管理局治疗环境中可能会遇到困难。目的：拟议的 CDA 项目的目标是开发所需的基础证据，以改善女性退伍军人获得最佳、性别敏感的 SUD 护理的机会。为了实现这一目标，我将检查患者、提供者和组织因素，这些因素促进或阻碍提供适当的和 使用混合方法对女性退伍军人进行有效护理。方法：拟议的 CDA 研究计划将包括 3 个独立的项目。第一个是对相关组织和患者层面数据的二次分析，将描述 VA 机构中女性 SUD 治疗参与（启动、参与和药物治疗）以及患者结果的模式和决定因素。第二项工作将包括制定和管理对女性退伍军人 VA SUD 护理组织结构的第一次调查。调查数据将与患者层面的数据联系起来，以确定女性 SUD 治疗结构对女退伍军人的治疗参与和患者结果的影响。第三个项目将是一项深入的定性研究，旨在向 VA SUD 女性患者了解她们接受 VA SUD 护理的经验以及她们对治疗障碍、偏好和需求的看法。拟议的 CDA 职业计划建立在我强大的流行病学和生物统计学培训的基础上，同时确保在使用 VA 数据源、卫生服务研究设计、物质使用障碍理论、心理健康中的性别问题、定性研究、组织方面进行教育、培训和指导。调查设计和实施科学。结论：为患有 SUD 的女性退伍军人提供以患者为中心、性别敏感的护理是 VA 的目标，但在 VA 中女性在何处以及如何获得 SUD 护理方面存在基本信息差距。此外，在确定最能满足女性退伍军人的具体需求和治疗障碍的护理特点方面，几乎没有做任何工作。拟议的研究将解决这些知识差距，为后续目标努力铺平道路，为女性退伍军人提供最佳的、对性别敏感的 SUD 护理。 公共卫生相关性： 努力为患有物质使用障碍 (SUD) 的女性退伍军人提供最佳的、以患者为中心的护理，需要了解其具体治疗需求和障碍的信息。拟议的 CDA 将使我能够建立一个职业生涯，改善向女性退伍军人提供性别敏感的 SUD 护理。计划的培训活动将使我获得使用 VA 数据、开展组织调查以及培养进行定性研究的能力的经验。计划中的研究将首次调查退伍军人在退伍军人事务部、医学专业和患者亚组中的 SUD 治疗模式； SUD 治疗对女性结局的影响； VA 中女性 SUD 护理的详细结构；以及女性对 VA SUD 护理的质量体验。这项研究直接解决了 VA HSR&D 在妇女健康研究中的优先事项，并支持 SUD-QUERI 为促进以患者为中心、基于证据的专业护理所做的努力。