VA Connecticut Healthcare System, West Haven, CT, USA.
Yale School of Medicine, New Haven, CT, USA.
Chiropr Man Therap. 2023 Aug 10;31(1):29. doi: 10.1186/s12998-023-00497-x.
Within the United States Veterans Health Administration (VHA), the number of patients using healthcare services has increased over the past several decades. Females make up a small proportion of overall patients within the VHA; however, this proportion is growing rapidly. Previous studies have described rates of VHA chiropractic use; however, no prior study assessed differences in use or utilization rates between male and female veterans. The purpose of this study was to assess rates of use and utilization of chiropractic care by sex among VHA patients receiving care at VHA facilities with on-station chiropractic clinics.
A serial cross-sectional analysis of VHA national electronic health record data was conducted in Fall 2021 for fiscal year (FY) 2005-2021. The cohort population was defined as VHA facilities with on-station chiropractic clinics, and facilities were admitted to the cohort after the first FY with a minimum of 500 on-station chiropractic visits. Variables extracted included counts of unique users of any VHA on-station facility outpatient services, unique users of VHA on-station facility chiropractic services, number of chiropractic visits, and sex. To calculate use, we determined the proportion of patients of each sex who received chiropractic services to the total patients of the same sex receiving any outpatient care within each facility. To calculate utilization, we determined the number of chiropractic care visits per patient per fiscal year. A linear mixed effects model was applied to examine the difference in chiropractic care utilization by sex.
The percentage of female VHA on-station chiropractic patients increased from 11.7 to 17.7% from FY2005-FY2021. Among VHA facilities with on-station chiropractic care, the percentage of female VHA healthcare users who used chiropractic care (mean = 2.3%) was greater than the percentage of male VHA healthcare users who used chiropractic care (mean = 1.1%). Rates of chiropractic utilization by sex among VHA facilities with on-station chiropractic clinics were slightly higher for females (median = 4.3 visits per year, mean = 4.9) compared to males (median = 4.1 visits per year, mean = 4.6).
We report higher use and utilization of VHA chiropractic care by females compared with males, yet for both sexes rates were lower than in the private US healthcare system. This highlights the need for further assessment of the determinants and outcomes of VHA chiropractic care.
在美国退伍军人健康管理局（VHA）内，使用医疗服务的患者人数在过去几十年中有所增加。女性在 VHA 中的患者比例较小；然而，这一比例正在迅速增长。先前的研究已经描述了 VHA 整脊使用的比率；然而，没有先前的研究评估男女退伍军人之间使用或利用率的差异。本研究的目的是评估在 VHA 设施中接受 VHA 护理的患者中，按性别划分的整脊护理使用率和利用率，这些设施设有站内整脊诊所。
2021 年秋季对 VHA 全国电子健康记录数据进行了一系列横断面分析，时间范围为 2005 财年至 2021 财年。队列人群被定义为设有站内整脊诊所的 VHA 设施，设施在首个至少有 500 次站内整脊就诊的 FY 被纳入队列。提取的变量包括任何 VHA 站内设施门诊服务的唯一使用者计数、VHA 站内设施整脊服务的唯一使用者计数、整脊就诊次数和性别。为了计算使用率，我们确定了每个性别的患者接受整脊服务的比例，占每个设施中同一性别接受任何门诊护理的患者总数的比例。为了计算利用率，我们确定了每位患者每财政年度的整脊护理就诊次数。应用线性混合效应模型来检查性别的整脊护理利用率差异。
从 2005 财年至 2021 财年，VHA 站内整脊患者中的女性比例从 11.7%增加到 17.7%。在设有站内整脊护理的 VHA 设施中，使用整脊护理的女性 VHA 医疗保健使用者的百分比（平均值=2.3%）大于使用整脊护理的男性 VHA 医疗保健使用者的百分比（平均值=1.1%）。设有站内整脊诊所的 VHA 设施中，女性的整脊利用率（中位数=每年 4.3 次就诊，平均值=4.9）略高于男性（中位数=每年 4.1 次就诊，平均值=4.6）。
我们报告了女性比男性更频繁地使用和利用 VHA 整脊护理，但对于两性来说，这一比率都低于美国私营医疗保健系统。这突出表明需要进一步评估 VHA 整脊护理的决定因素和结果。
