Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
San Francisco VA Health Care System, San Francisco, CA, USA.
J Gen Intern Med. 2023 Nov;38(14):3188-3197. doi: 10.1007/s11606-023-08257-6. Epub 2023 Jun 8.
Capturing military sexual trauma (MST) exposure is critical for Veterans' health equity. For many, it improves access to VA services and allows for appropriate care.
Identify factors associated with nondisclosure of MST in VA screening among women.
Cross-sectional telephone survey linked with VA electronic health record (EHR) data.
Women Veterans using primary care or women's health services at 12 VA facilities in nine states.
Survey self-reported MST (sexual assault and/or harassment during military service), socio-demographics and experiences with VA care, as well as EHR MST results. Responses were categorized as "no MST" (no survey or EHR MST), "MST captured by EHR and survey," and "MST not captured by EHR" (survey MST but no EHR MST). We used stepped multivariable logistic regression to examine "MST not captured by EHR" as a function of socio-demographics, patient experiences, and screening method (survey vs. EHR).
Among 1287 women (mean age 50, SD 15), 35% were positive for MST by EHR and 61% were positive by survey. Approximately 38% had "no MST," 34% "MST captured by EHR and survey," and 26% "MST not captured by EHR". In fully adjusted models, odds of "MST not captured by EHR" were higher among Black and Latina women compared to white women (Black: OR = 1.6, 1.2-2.2; Latina: OR = 1.9, 1.0-3.6). Women who endorsed only sexual harassment in the survey (vs. sexual harassment and sexual assault) had fivefold higher odds of "MST not captured by EHR" (OR = 4.9, 3.2-7.3). Women who were screened for MST in the EHR more than once had lower odds of not being captured (OR = 0.3, 0.2-0.4).
VA screening for MST may disproportionately under capture patients from historically minoritized ethnic/racial groups, creating inequitable access to resources. Efforts to mitigate screening disparities could include re-screening and reinforcing that MST includes sexual harassment.
捕捉军事性创伤 (MST) 暴露对于退伍军人的健康公平至关重要。对许多人来说，这可以改善他们获得 VA 服务的机会，并提供适当的护理。
确定与女性在 VA 筛查中隐瞒 MST 相关的因素。
与 VA 电子健康记录 (EHR) 数据相关联的横断面电话调查。
在 9 个州的 12 个 VA 设施使用初级保健或妇女保健服务的女性退伍军人。
调查自我报告的 MST（军事服务期间的性侵犯和/或骚扰）、社会人口统计学和 VA 护理体验，以及 EHR MST 结果。答复被归类为“无 MST”（无调查或 EHR MST）、“MST 通过调查和 EHR 捕获”和“MST 未通过 EHR 捕获”（调查 MST 但无 EHR MST）。我们使用逐步多变量逻辑回归来检查“EHR 未捕获的 MST”作为社会人口统计学、患者体验和筛查方法（调查与 EHR）的函数。
在 1287 名女性（平均年龄 50 岁，标准差 15）中，35% 通过 EHR 呈 MST 阳性，61% 通过调查呈 MST 阳性。大约 38% 的人“无 MST”，34% 的人“EHR 和调查捕获的 MST”，26% 的人“EHR 未捕获的 MST”。在完全调整的模型中，与白人女性相比，黑人和拉丁裔女性“EHR 未捕获的 MST”的可能性更高（黑人：OR=1.6，1.2-2.2；拉丁裔：OR=1.9，1.0-3.6）。在调查中仅报告性骚扰的女性（与性侵犯和性侵犯相比）“EHR 未捕获的 MST”的可能性高五倍（OR=4.9，3.2-7.3）。在 EHR 中多次接受 MST 筛查的女性“EHR 未捕获的 MST”的可能性较低（OR=0.3，0.2-0.4）。
VA 对 MST 的筛查可能不成比例地低估了来自历史上少数族裔/种族群体的患者，从而导致资源获取不平等。减轻筛查差异的努力可能包括重新筛查和加强 MST 包括性骚扰。
