Comparison of outpatient health care utilization among returning women and men veterans from Afghanistan and Iraq
Goulet, Joseph L.
Mattocks, Kristin M.
Haskell, Sally G.
Justice, Amy C.
Brandt, Cynthia A.
UMass Chan AffiliationsDepartment of Quantitative Health Sciences
Afghan Campaign 2001-
Ambulatory Care Facilities
Iraq War, 2003-2011
Veteran Administration Health
Private Health Insurance
Incident Rate Ratio
Health Care Service Utilization
Gender and Sexuality
Health Services Administration
Health Services Research
Military and Veterans Studies
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AbstractBACKGROUND: The number of women serving in the United States military increased during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), leading to a subsequent surge in new women Veterans seeking health care services from the Veterans Administration (VA). The objective of this study was to examine gender differences among OEF/OIF Veterans in utilization of VA outpatient health care services. METHODS: Our retrospective cohort consisted of 1,620 OEF/OIF Veterans (240 women and 1380 men) who enrolled for outpatient healthcare at a single VA facility. We collected demographic data and information on military service and VA utilization from VA electronic medical records. To assess gender differences we used two models: use versus nonuse of services (logistic regression) and intensity of use among users (negative binomial regression). RESULTS: In our sample, women were more likely to be younger, single, and non-white than men. Women were more likely to utilize outpatient care services (odds ratio [OR] = 1.47, 95% confidence interval [CI]:1.09, 1.98), but once care was initiated, frequency of visits over time (intensity) did not differ by gender (incident rate ratio [IRR] = 1.07; 95% CI: 0.90, 1.27). CONCLUSION: Recently discharged OEF/OIF women Veterans were more likely to seek VA health care than men Veterans. But the intensity of use was similar between women and men VA care users. As more women use VA health care, prospective studies exploring gender differences in types of services utilized, health outcomes, and factors associated with satisfaction will be required.
BMC Health Serv Res. 2010 Jun 22;10:175. doi: 10.1186/1472-6963-10-175. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/51036
At the time of publication, Kristin Mattocks was not yet affiliated with the University of Massachusetts Medical School.
Rights© Duggal et al; licensee BioMed Central Ltd. 2010 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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The burden of illness in the first year home: do male and female VA users differ in health conditions and healthcare utilizationHaskell, Sally; Mattocks, Kristin M; Goulet, Joseph; Krebs, Erin; Skanderson, Melissa; Leslie, Douglas; Justice, Amy C.; Yano, Elizabeth M.; Brandt, Cynthia A. (2011-01-01)BACKGROUND: we sought to describe gender differences in medical and mental health conditions and health care utilization among veterans who used Veterans Health Administration (VA) services in the first year after combat in Iraq and Afghanistan. METHODS: this is an observational study, using VA administrative and clinical data bases, of 163,812 Operation Enduring Freedom/Operation Iraqi Freedom veterans who had enrolled in VA and who had at least one visit within 1 year of last deployment. RESULTS: female veterans were slightly younger (mean age, 30 years vs. 32 for men; p
Women veterans' reproductive health preferences and experiences: a focus group analysisMattocks, Kristin M.; Nikolajski, Cara; Haskell, Sally G.; Brandt, Cynthia A.; McCall-Hosenfeld, Jennifer; Yano, Elizabeth M.; Pham, Tan; Borrero, Sonya (2011-03-01)OBJECTIVE: Although women veterans are seeking care at the Veterans Administration (VA) in record numbers, there is little information regarding women veterans' experiences and preferences for reproductive health care services. We sought to characterize women veterans' experiences with, and preferences for, reproductive health services in the VA. METHODS: We conducted five focus groups with a total of 25 participants using a semistructured interview guide to elicit women veterans' experiences and preferences with reproductive health care. Women veterans' utilizing VA health care at two VA facilities who responded to advertisements were selected on a first-come basis to participate in the study. We analyzed transcripts of these audio-recorded sessions using the constant comparative method of grounded theory. RESULTS: Five main themes emerged from the focus group discussions: 1) Women veterans prefer VA women's clinics for comprehensive medical care; 2) Women veterans have had both positive and negative reproductive health experiences in the VA; 3) Women veterans experience knowledge gaps regarding VA coverage for reproductive health services; 4) Women veterans believe the VA should provide additional coverage for advanced infertility care and for newborns; and 5) Perceived gender discrimination shapes how women veterans view the VA. CONCLUSION: As the VA continues to tailor its services to women veterans, attention should be given to women's reproductive health care needs. All rights reserved.
Sexual victimization, health status, and VA healthcare utilization among lesbian and bisexual OEF/OIF veteransMattocks, Kristin M; Sadler, Anne; Yano, Elizabeth M.; Krebs, Erin E.; Zephyrin, Laurie; Brandt, Cynthia; Kimerling, Rachel; Sandfort, Theo; Dichter, Melissa E.; Weiss, Jeffrey J.; et al. (2013-07-01)BACKGROUND: Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA. OBJECTIVE: The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving. DESIGN: Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities. PARTICIPANTS: Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %). MAIN MEASURES: Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction. KEY RESULTS: LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p < .001; childhood sexual trauma: 60 % vs. 36 %, p = .01), to be hazardous drinkers (32 % vs. 16 %, p = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p < .001). CONCLUSIONS: Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.