Utilization and intensity of outpatient care related to military sexual trauma for veterans from Afghanistan and Iraq.

Little research has examined factors associated with the utilization of outpatient health care services related to sexual assault experiences. The Veterans Health Administration provides free outpatient treatment services to veterans who report military sexual trauma (MST); this system provides a unique opportunity to examine factors related to the utilization of mental health and non-mental health outpatient services by patients with sexual trauma. The current study examined sociodemographic, military service factors, and primary diagnoses related to utilization and utilization intensity of MST-related care among 4,458 Operation Enduring Freedom/Operation Iraqi Freedom Veterans in a 1-year period after reporting an experience of MST. Of the veterans who reported MST, 75.9% received MST-related care. The most notable factor that influenced receipt and intensity of MST-related care was gender, where male veterans used less care than female veterans. These results have important treatment implications for both veteran and civilian sexual trauma survivors.

Military sexual trauma and patient perceptions of Veteran Health Administration health care quality.

BACKGROUND: Although sexual trauma is associated with poorer patient perceptions of health care quality, few studies have investigated this relationship in settings with comprehensive policies surrounding detection and treatment of sexual trauma, such as the Veterans Health Administration (VHA). We examined the association of military sexual trauma (MST) with patient satisfaction with VHA outpatient care among men and women. METHODS: This is a cross-sectional study of a national representative sample of 164,632 VHA outpatients (5,758 women and 158,884 men) from fiscal year 2007. Measures included MST status, patients' ratings of overall satisfaction with VHA care in the last 2 months, and nine other dimensions of patient satisfaction. We assessed bivariate and multivariate associations between MST and overall satisfaction and each dimension of patient satisfaction. Multivariate models were adjusted for demographic characteristics, health status, and medical utilization. All analyses were stratified by gender. FINDINGS: The proportion of patients reporting very good or excellent overall satisfaction was 78.5% for men and 72.3% for women. Findings showed that, once confounding was controlled, men and women veterans' MST status was not associated with satisfaction ratings of VHA health care overall. However, women veterans with a history of MST rated the dimensions of overall coordination and education and information less favorably than women veterans without an MST history. Post hoc analysis of individual items in these domains suggested that areas of improvement might include greater attention to provider-patient communication, including communication across multiple providers. There was no association between men's MST status and subdomains of health care satisfaction. CONCLUSION: Patient ratings of overall satisfaction of VHA care are high. Opportunities exist, however, to educate providers on the special coordination needs of female veterans with histories of MST. These female veterans might benefit from care coordination. When investigating satisfaction in patients with histories of sexual trauma, our findings suggest the importance of adjusting analyses for important patient characteristics.

Veterans Health Administration mental health treatment settings of patients who report military sexual trauma.

The comprehensive Veterans Health Administration (VHA) policies on military sexual trauma (MST) include provider education and training at each VHA facility. No published data exist that indicate the settings in which VHA mental health patients with MST are treated. Such information could help set priorities for targeted MST-related education and training. The major aim of this article was to describe the VHA mental health outpatient settings in which patients with MST are most likely to be treated. National data from 79,903 female and 889,998 male veteran patients with at least one face-to-face outpatient mental health encounter at any VHA facility in fiscal year 2008 were analyzed. Among all veterans in VHA outpatient mental health care, 35.8% of women and 2.4% of men reported MST. The proportion of MST-positive patients ranged from 25.9% to 81.0% of women and from 1.5% to 56.1% of men across 9 major clinic setting categories. Proportions of women with MST were substantial across specialty MST clinics, specialty posttraumatic stress disorder clinics, psychosocial rehabilitation, and substance use disorder clinics, reflecting a wide range of settings. These settings should be prioritized for MST-related provider education and training. By contrast, male MST patients represented only a small proportion of patients in all clinics, with the exception of MST specialty clinics. Tailored conceptualizations of trauma-informed care are proposed for settings that encounter MST patients, even if these settings do not directly focus on the treatment of traumatic stress.