Kimerling Rachel, Iverson Katherine M, Dichter Melissa E, Rodriguez Allison L, Wong Ava, Pavao Joanne
Department of Veterans Affairs, National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA.
Department of Veterans Affairs, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
J Gen Intern Med. 2016 Aug;31(8):888-94. doi: 10.1007/s11606-016-3701-7. Epub 2016 Apr 29.
The objectives of this study were to identify the prevalence of past-year intimate partner violence (IPV) among women Veterans utilizing Veterans Health Administration (VHA) primary care, and to document associated demographic, military, and primary care characteristics.
This was a retrospective cohort design, where participants completed a telephone survey in 2012 (84% participation rate); responses were linked to VHA administrative data for utilization in the year prior to the survey.
A national stratified random sample of 6,287 women Veteran VHA primary care users participated in the study.
Past-year IPV was assessed using the HARK screening tool. Self-report items and scales assessed demographic and military characteristics. Primary care characteristics were assessed via self-report and VHA administrative data.
The prevalence of past-year IPV among women Veterans was 18.5% (se = 0.5%), with higher rates (22.2% - 25.5%) among women up to age 55. Other demographic correlates included indicators of economic hardship, lesbian or bisexual orientation, and being a parent/guardian of a child less than 18 years old. Military correlates included service during Vietnam to post-Vietnam eras, less than 10 years of service, and experiences of Military Sexual Trauma (MST). Most (77.3%, se = 1.2%) women who experienced IPV identified a VHA provider as their usual provider. Compared with women who did not report past-year IPV, women who reported IPV had more primary care visits, yet experienced lower continuity of care across providers.
The high prevalence of past-year IPV among women beyond childbearing years, the majority of whom primarily rely on VHA as a source of health care, reinforces the importance of screening all women for IPV in VHA primary care settings. Key considerations for service implementation include sensitivity with respect to sexual orientation, race/ethnicity, and other aspects of diversity, as well as care coordination and linkages with social services and MST-related care.
本研究的目的是确定利用退伍军人健康管理局(VHA)初级保健服务的女性退伍军人中过去一年亲密伴侣暴力(IPV)的患病率,并记录相关的人口统计学、军事和初级保健特征。
这是一项回顾性队列研究设计,参与者于2012年完成了一项电话调查(参与率为84%);调查结果与VHA行政数据相关联,用于调查前一年的情况。
6287名使用VHA初级保健服务的女性退伍军人的全国分层随机样本参与了本研究。
使用HARK筛查工具评估过去一年的IPV情况。通过自我报告项目和量表评估人口统计学和军事特征。通过自我报告和VHA行政数据评估初级保健特征。
女性退伍军人中过去一年IPV的患病率为18.5%(标准误=0.5%),55岁及以下女性的患病率较高(22.2%-25.5%)。其他人口统计学相关因素包括经济困难指标、女同性恋或双性恋取向以及作为18岁以下儿童的父母/监护人。军事相关因素包括越战至越战后期服役、服役年限少于10年以及军事性创伤(MST)经历。大多数经历IPV的女性(77.3%,标准误=1.2%)将VHA提供者视为其常规提供者。与未报告过去一年IPV的女性相比,报告IPV的女性有更多的初级保健就诊次数,但在不同提供者之间的护理连续性较低。
育龄后女性中过去一年IPV的高患病率,其中大多数主要依靠VHA作为医疗保健来源,这强化了在VHA初级保健环境中对所有女性进行IPV筛查的重要性。服务实施的关键考虑因素包括对性取向、种族/民族和其他多样性方面的敏感性,以及护理协调和与社会服务及MST相关护理的联系。