理解利用综合护理模式为女性退伍军人提供孕产护理协调。
Understanding Maternity Care Coordination for Women Veterans Using an Integrated Care Model Approach.
机构信息
VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
出版信息
J Gen Intern Med. 2019 May;34(Suppl 1):50-57. doi: 10.1007/s11606-019-04974-z.
BACKGROUND
An increasing number of women veterans are using VA maternity benefits for their pregnancies. However, because the VA does not offer obstetrical care, women must seek maternity care from non-VA providers. The growing number of women using non-VA care has increased the importance of understanding how this care is integrated with ongoing VA medical and mental health services and how perceptions of care integration impact healthcare utilization. Therefore, we sought to understand these relationships among a sample of postpartum veterans utilizing VA maternity benefits.
METHODS
We fielded a modified version of the Patient Perceptions of Integrated Care survey among a sample of postpartum veterans who had utilized VA maternity benefits for their pregnancies (n = 276). We assessed relationships between perceptions of six domains of patient-reported integrated care, indicating how well-integrated patients perceived the care received from VA and non-VA clinicians, and utilization of mental healthcare following pregnancy.
RESULTS
Domain scores were highest for items focused on VA care, including test result communication and VA provider's knowledge of patient's medical conditions. Scores were lower for obstetrician's knowledge of patient's medical history. Women with depressive symptom scores indicative of depression rated test result communication as highly integrated, while women who received mental healthcare following pregnancy had low integrated care ratings for the Support for Medication and Home Health Management domain, indicating a lack of support for mental health conditions following pregnancy.
DISCUSSION
Among a group of postpartum veterans, poor ratings of integrated care across some domains were associated with higher rates of mental healthcare use following pregnancy. Further assessment of integrated care by patients may assist VA providers and policymakers in developing systems to ensure integrated care for veterans who receive care outside the VA.
背景
越来越多的女性退伍军人正在利用 VA 产妇福利来生育。然而，由于 VA 不提供产科护理，女性必须从非 VA 提供商那里寻求产妇护理。越来越多的女性使用非 VA 护理增加了了解这种护理如何与 VA 医疗和心理健康服务相结合的重要性，以及对护理整合的看法如何影响医疗保健的利用。因此，我们试图了解利用 VA 产妇福利的产后退伍军人样本中的这些关系。
方法
我们在利用 VA 产妇福利生育的产后退伍军人样本（n=276）中进行了经过修改的患者感知综合护理调查。我们评估了六个患者报告的综合护理领域的感知之间的关系，这些领域表明患者对从 VA 和非 VA 临床医生那里获得的护理的整合程度，以及产后心理健康保健的利用情况。
结果
与关注 VA 护理的项目相关的领域得分最高，包括测试结果的沟通和 VA 提供者对患者病情的了解。产科医生对患者病史的了解得分较低。有抑郁症状评分表明有抑郁的女性将测试结果的沟通评价为高度整合，而在产后接受心理健康保健的女性在药物治疗和家庭健康管理支持方面的综合护理评价较低，表明在产后缺乏对心理健康状况的支持。
讨论
在一组产后退伍军人中，一些领域的综合护理评价较差与产后心理健康保健的使用率较高有关。患者对综合护理的进一步评估可能有助于 VA 提供者和政策制定者开发系统，以确保接受 VA 以外护理的退伍军人获得综合护理。
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