Washington Donna L, Farmer Melissa M, Mor Su Sun, Canning Mark, Yano Elizabeth M
*VA Greater Los Angeles Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda and Los Angeles †Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine ‡Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA.
Med Care. 2015 Apr;53(4 Suppl 1):S23-31. doi: 10.1097/MLR.0000000000000312.
Prior regional studies of women Veterans identified barriers to Veterans Affairs (VA) healthcare use. However, these studies do not reflect the demographic profile of women Veterans nationally, recent advances in VA women's healthcare, and the national context of expanded healthcare alternatives.
To characterize health, VA perceptions, barriers, healthcare delivery preferences, and reasons for VA or non-VA healthcare use in a national women Veteran sample.
Cross-sectional, population-based 2008-2009 National Survey of Women Veterans (n=3611).
VA users had worse physical and mental health than non-VA-only users and healthcare nonusers. Older women Veterans had worse physical health, whereas younger groups had worse mental health. Healthcare use was highest for dual users, followed by VA-only users, but did not differ by age group. Healthcare nonusers were most likely to lack a regular source for healthcare. Perceptions of VA care quality and sex-appropriateness were highest for VA-only, followed by dual, then non-VA-only users. VA perceptions were guided by personal experience for 90% of VA users, versus media or other secondhand sources for 70% of other groups. Non-VA-only users and healthcare nonusers had more knowledge gaps about VA and misperceptions about VA eligibility and services; non-VA-only users more likely encountered VA enrollment barriers.
Many nonusers had healthcare needs that were not met. Positive VA perceptions by women with first-hand VA experience, contrasted with VA knowledge gaps by those without such exposure, suggests the need for more education about available VA healthcare services. VA planning should account for mental health needs and healthcare use by younger women Veterans.
先前针对女性退伍军人的地区性研究确定了退伍军人事务部（VA）医疗保健使用方面的障碍。然而，这些研究并未反映全国女性退伍军人的人口统计学特征、VA女性医疗保健的最新进展以及医疗保健选择扩大的全国背景。
在全国女性退伍军人样本中，描述健康状况、对VA的看法、障碍、医疗保健提供偏好以及使用VA或非VA医疗保健的原因。
基于人群的横断面2008 - 2009年全国女性退伍军人调查（n = 3611）。
使用VA医疗保健的退伍军人的身心健康状况比仅使用非VA医疗保健的退伍军人和不使用医疗保健的人更差。年长的女性退伍军人身体健康状况较差，而年轻群体心理健康状况较差。双重使用者的医疗保健使用率最高，其次是仅使用VA医疗保健的人，但不同年龄组之间没有差异。不使用医疗保健的人最有可能缺乏常规的医疗保健来源。仅使用VA医疗保健的人对VA护理质量和性别适宜性的看法最高，其次是双重使用者，然后是仅使用非VA医疗保健的人。90%的VA使用者对VA的看法是基于个人经验，而其他群体中有70%是基于媒体或其他二手来源。仅使用非VA医疗保健的退伍军人和不使用医疗保健的人对VA的了解差距更大，对VA资格和服务存在误解；仅使用非VA医疗保健的退伍军人更有可能遇到VA注册障碍。
许多不使用医疗保健的人有未得到满足的医疗保健需求。有VA第一手经验的女性对VA的积极看法，与没有这种经历的人对VA的知识差距形成对比，这表明需要对可用的VA医疗保健服务进行更多教育。VA规划应考虑年轻女性退伍军人的心理健康需求和医疗保健使用情况。
