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1.
Am J Occup Ther ; 78(5)2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39054682

RESUMO

IMPORTANCE: Visual-motor integration (VMI) is typically examined in children to promote handwriting, but it may also be relevant for adults' capacity for technology use. OBJECTIVE: To examine the reliability and validity of speed of completion of the box clicking test, a web-based test of VMI. DESIGN: Participants in the Understanding America Study completed online surveys on a regular basis, including a very brief (less than 30 s) self-administered box clicking test. For validity testing, we examined whether box clicking speed was associated with constructs relevant to visual-perceptual skills and motor coordination, the skills underlying VMI. Test-retest reliability was examined by computation of intraclass correlation coefficients. PARTICIPANTS: A total of 11,114 adults. MEASURES: Measures included the completion time for the box clicking task and measures relevant to visual perception (e.g., perceptual speed) and motor coordination (e.g., self-reported functional limitation). RESULTS: Results suggested that the box clicking test was a VMI task. Slower test performance was associated with lower visual-perceptual speed and a greater likelihood of reporting difficulties with dressing, a motor coordination relevant task. Box clicking tests taken within at least 2 yr of one another had moderate test-retest stability, but future studies are needed to examine test-retest reliabilities over brief (e.g., 2-wk) time intervals. CONCLUSIONS AND RELEVANCE: The box clicking test may serve both as a tool for research and to clinically observe whether clients have VMI difficulties that interfere with computer, smartphone, or tablet use. Plain-Language Summary: Use of devices such as smartphones and computers is increasingly becoming integral for daily functioning. Visual-motor integration (VMI) has often been addressed by occupational therapists to support handwriting of children, but it may also be important for technology use by adults. Prior literature supports the relevance of VMI to technology use, and adults with various chronic conditions have been found to have decrements in VMI. We tested the psychometric properties of a brief box clicking test of VMI that could be used to examine VMI underlying technology use among adults. Overall, results suggested that the box clicking test was a VMI task. Just as speed of gait has been used as an index of functional mobility, speed on the box clicking task seemed serviceable as an index of VMI ability. The box clicking test may also be used for clinical observation of whether VMI interferes with technology use.


Assuntos
Desempenho Psicomotor , Percepção Visual , Humanos , Masculino , Feminino , Adulto , Reprodutibilidade dos Testes , Pessoa de Meia-Idade , Computadores de Mão , Destreza Motora , Adulto Jovem , Smartphone , Adolescente , Idoso
2.
J Gerontol B Psychol Sci Soc Sci ; 78(2): 201-209, 2023 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-36308489

RESUMO

OBJECTIVES: The Health and Retirement Study Telephone Interview for Cognitive Status (HRS TICS) score and its associated Langa-Weir cutoffs are widely used as indicators of cognitive status for research purposes in population-based studies. The classification is based on in-person and phone interviews of older individuals. Our purpose was to develop a corresponding classification for web-based self-administered assessments. METHODS: Participants were 925 members of a nationally representative internet panel, all aged 50 and older. We conducted (a) a phone interview comprised of cognitive items used to construct the HRS TICS score, and (b) a web counterpart with self-administered cognitive items, while also considering (c) other already administered web-based cognitive tests and instrumental activities of daily living survey questions, all from the same respondents. RESULTS: The web-administered HRS TICS items have only modest correlations with the same phone items, although neither mode showed universally higher scores than the other. Using latent variable modeling, we created a probability of cognitive impairment score for the web-based battery that achieved good correspondence to the phone Langa-Weir classification. DISCUSSION: The results permit analyses of predictors, correlates, and consequences of cognitive impairment in web surveys where relevant cognitive test and functional abilities items are available. We discuss challenges and caveats that may affect the findings.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Demência , Humanos , Pessoa de Meia-Idade , Idoso , Demência/psicologia , Transtornos Cognitivos/psicologia , Atividades Cotidianas , Testes Neuropsicológicos , Internet
4.
J Med Internet Res ; 24(5): e34347, 2022 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-35532966

RESUMO

BACKGROUND: Cognitive testing in large population surveys is frequently used to describe cognitive aging and determine the incidence rates, risk factors, and long-term trajectories of the development of cognitive impairment. As these surveys are increasingly administered on internet-based platforms, web-based and self-administered cognitive testing calls for close investigation. OBJECTIVE: Web-based, self-administered versions of 2 age-sensitive cognitive tests, the Stop and Go Switching Task for executive functioning and the Figure Identification test for perceptual speed, were developed and administered to adult participants in the Understanding America Study. We examined differences in cognitive test scores across internet device types and the extent to which the scores were associated with self-reported distractions in everyday environments in which the participants took the tests. In addition, national norms were provided for the US population. METHODS: Data were collected from a probability-based internet panel representative of the US adult population-the Understanding America Study. Participants with access to both a keyboard- and mouse-based device and a touch screen-based device were asked to complete the cognitive tests twice in a randomized order across device types, whereas participants with access to only 1 type of device were asked to complete the tests twice on the same device. At the end of each test, the participants answered questions about interruptions and potential distractions that occurred during the test. RESULTS: Of the 7410 (Stop and Go) and 7216 (Figure Identification) participants who completed the device ownership survey, 6129 (82.71% for Stop and Go) and 6717 (93.08% for Figure Identification) participants completed the first session and correctly responded to at least 70% of the trials. On average, the standardized differences across device types were small, with the absolute value of Cohen d ranging from 0.05 (for the switch score in Stop and Go and the Figure Identification score) to 0.13 (for the nonswitch score in Stop and Go). Poorer cognitive performance was moderately associated with older age (the absolute value of r ranged from 0.32 to 0.61), and this relationship was comparable across device types (the absolute value of Cohen q ranged from 0.01 to 0.17). Approximately 12.72% (779/6123 for Stop and Go) and 12.32% (828/6721 for Figure Identification) of participants were interrupted during the test. Interruptions predicted poorer cognitive performance (P<.01 for all scores). Specific distractions (eg, watching television and listening to music) were inconsistently related to cognitive performance. National norms, calculated as weighted average scores using sampling weights, suggested poorer cognitive performance as age increased. CONCLUSIONS: Cognitive scores assessed by self-administered web-based tests were sensitive to age differences in cognitive performance and were comparable across the keyboard- and touch screen-based internet devices. Distraction in everyday environments, especially when interrupted during the test, may result in a nontrivial bias in cognitive testing.


Assuntos
Disfunção Cognitiva , Humanos , Internet , Testes Neuropsicológicos , Probabilidade , Inquéritos e Questionários
5.
PLoS One ; 16(9): e0256406, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34496006

RESUMO

BACKGROUND: The COVID-19 pandemic brought about large increases in mental distress. The uptake of COVID-19 vaccines is expected to significantly reduce health risks, improve economic and social outcomes, with potential benefits to mental health. PURPOSE: To examine short-term changes in mental distress following the receipt of the first dose of the COVID-19 vaccine. METHODS: Participants included 8,003 adults from the address-based sampled, nationally representative Understanding America Study (UAS), surveyed at regular intervals between March 10, 2020, and March 31, 2021 who completed at least two waves of the survey. Respondents answered questions about COVID-19 vaccine status and self-reported mental distress as measured with the four-item Patient Health Questionnaire (PHQ-4). Fixed-effects regression models were used to identify the change in PHQ-4 scores and categorical indicators of mental distress resulting from the application of the first dose of the COVID-19 vaccine. RESULTS: People who were vaccinated between December 2020 and March 2021 reported decreased mental distress levels in the surveys conducted after receiving the first dose. The fixed-effects estimates show an average effect of receiving the vaccine equivalent to 4% of the standard deviation of PHQ-4 scores (p-value<0.01), a reduction in 1 percentage point (4% reduction from the baseline level) in the probability of being at least mildly depressed, and of 0.7 percentage points (15% reduction from the baseline level) in the probability of being severely depressed (p-value = 0.06). CONCLUSIONS: Getting the first dose of COVID-19 resulted in significant improvements in mental health, beyond improvements already achieved since mental distress peaked in the spring of 2020.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/imunologia , COVID-19/psicologia , Transtornos Mentais/psicologia , SARS-CoV-2/imunologia , Feminino , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Questionário de Saúde do Paciente/estatística & dados numéricos , Angústia Psicológica , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
6.
PLoS One ; 15(9): e0238341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886671

RESUMO

As COVID-19 is rapidly unfolding in the United States, it is important to understand how individuals perceive the health and economic risks of the pandemic. In the absence of a readily available medical treatment, any strategy to contain the virus in the US will depend on the behavioral response of US residents. In this paper, we study individual's perceptions on COVID-19 and social distancing during the week of March 10-16, 2020, a week when COVID-19 was officially declared to be a pandemic by WHO and when new infections in the US were more than doubling every three days. Using a nationally representative sample of 5,414 respondents 18+ years of age from the Understanding America Study (UAS), we find that perceptions about COVID-19 health risks and economic consequences in the US population were largely pessimistic and highly variable by age and education. US residents who are young and do not have a college degree perceived a lower risk of getting infected but a higher probability of running out of money than others. Most individuals reported taking some steps to distance themselves from others but important differences emerge by gender and by source of information on COVID-19. Using state and day fixed-effect regressions, we show that perceptions of the health risks closely followed the number of COVID-19 cases in the country, and perceptions of the economic consequences and the prevalence of social distancing were driven upwards by both national and state-level cases. Unless addressed by effective health communication that reaches individuals across all social strata, variations in perceptions about COVID-19 epidemic raise concerns about the ability of the US to implement and sustain the widespread and restrictive policies that are required to curtail the pandemic.


Assuntos
Infecções por Coronavirus/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pneumonia Viral/psicologia , Quarentena/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pessimismo , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Autorrelato , Isolamento Social , Estados Unidos
7.
Health Serv Res ; 54(4): 816-826, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30989651

RESUMO

OBJECTIVE: To examine the relationship between care fragmentation and patient ratings of care quality and identify potentially actionable mediators. DATA SOURCES/STUDY SETTING: 2015 telephone survey of 1395 women Veterans with three or more visits in primary care and/or women's health care in the prior year at 12 Veterans Affairs (VA) medical centers. STUDY DESIGN: Cross-sectional analysis. DATA COLLECTION/EXTRACTION METHODS: We operationalized lower care fragmentation as receiving VA-only care versus dual use of VA/non-VA care. Participants rated VA care quality (overall care, women's health care (WH), and primary care (PC)) and three aspects of their patient experience (ease of access to services, provider communication, and gender sensitivity of VA environments). We examined associations between care fragmentation and care ratings and applied the Karlson-Holm-Breen decomposition method to test for mediation by aspects of patients' experience. PRINCIPAL FINDINGS: Lower care fragmentation was associated with higher ratings of care quality (odds ratios [95% CI] for overall care: 1.57 [1.14;2.17]; WH: 1.65 [1.20;2.27]; PC: 1.41 [1.10;1.82]). Relationships were mediated by patient-rated provider communication and gender sensitivity (26-54 percent and 14-15 percent of total effects, respectively). Ease of access was associated with higher care ratings (odds ratios [95% CI] for overall care: 2.93 [2.25;3.81]; WH: 2.81 [2.15;3.68]; PC: 2.33 [1.63;3.33], in models with the three types of patient care experiences included), but did not mediate the association of care fragmentation and care ratings. CONCLUSIONS: Potential negative effects of care fragmentation on care quality ratings could be mitigated by attention to quality of patient-provider communication and gender sensitivity of VA environments.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Satisfação do Paciente , Qualidade da Assistência à Saúde/organização & administração , Veteranos , Saúde da Mulher , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Comunicação , Continuidade da Assistência ao Paciente/normas , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Relações Profissional-Paciente , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs , Adulto Jovem
8.
Womens Health Issues ; 29(2): 107-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30686577

RESUMO

BACKGROUND: Harassment of servicewomen during military service has been well-documented, but harassment of women veterans in Veterans Affairs (VA) health care settings has not been studied systematically. We assessed the prevalence and impacts of harassment among women veterans who use VA health care. METHODS: From January to March 2015, we conducted computer-assisted telephone interviews of randomly sampled women veterans with three or more primary care and/or women's health visits at 1 of 12 VA medical centers. We asked if patients had experienced inappropriate/unwanted comments or behavior from male veterans at VA in the past year. We measured sociodemographics, health status, perceptions of VA care, delayed/unmet health care need, and care preferences. All analyses were weighted to account for the disproportionate sample design and nonresponse. Brief, open-ended descriptions of harassment were transcribed and coded. RESULTS: Approximately one in four women veterans (25.2%; n = 1,395, response rate 45%) reported inappropriate/unwanted comments or behavior by male veterans on VA grounds. Site prevalence ranged from 10% to 42%. Incident descriptions were wide-ranging (e.g., catcalls, sexual/derogatory remarks, propositioning, stalking, and denigration of veteran status). Reports of harassment were more common among women with histories of military sexual trauma; other trauma exposures (e.g., combat, childhood); positive screens for anxiety, depression, and/or posttraumatic stress disorder; and fair/poor health. Those who reported harassment were significantly less likely to report feeling welcome at VA, and more likely to report not feeling safe, and delaying/missing care. CONCLUSIONS: One-quarter of women veteran VA users experienced harassment in VA health care settings; these experiences negatively impacted women's health care experiences and use.


Assuntos
Agressão , Violência de Gênero , Acessibilidade aos Serviços de Saúde , Hospitais de Veteranos , Militares , United States Department of Veterans Affairs , Veteranos , Adolescente , Adulto , Ansiedade , Conflitos Armados/psicologia , Vítimas de Crime/psicologia , Depressão , Feminino , Violência de Gênero/estatística & dados numéricos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Transtornos Relacionados a Trauma e Fatores de Estresse/etiologia , Estados Unidos , Veteranos/psicologia , Saúde dos Veteranos , Saúde da Mulher , Adulto Jovem
9.
BMC Fam Pract ; 19(1): 149, 2018 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-30170541

RESUMO

BACKGROUND: Poor morale among primary care providers (PCPs) and staff can undermine the success of patient-centered care models such as the patient-centered medical home that rely on highly coordinated inter-professional care teams. Medical home literature hypothesizes that participation in quality improvement can ease medical home transformation. No studies, however, have assessed the impact of quality improvement participation on morale (e.g., burnout or dissatisfaction) during transformation. The objective of this study is to examine whether primary care practices participating in evidence-based quality improvement (EBQI) during medical home transformation reduced burnout and increased satisfaction over time compared to non-participating practices. METHODS: We used a longitudinal quasi-experimental design to examine the impact of EBQI (vs. no EBQI), a multi-level, interdisciplinary approach for engaging frontline primary care practices in developing evidence-based improvement innovations and tools for spread on PCP and staff morale following the 2010 national implementation of the medical home model in the Veterans Health Administration. The sample included 356 primary care employees (107 primary care providers and 249 staff) from 23 primary care practices (6 intervention and 17 comparison) within one Veterans Health Administration region. Three intervention practices began EBQI in 2011 (early) and three more began EBQI in 2012 (late). Three waves of surveys were administered across 42 months beginning in November 2011 and ending in January 2016 approximately 2 years 18 months apart. We used repeated measures analysis of the survey data on medical home teams. Main outcome measures were the emotional exhaustion subscale from the Maslach Burnout Inventory, and job satisfaction. RESULTS: Six of 26 approved EBQI innovations directly addressed provider and staff morale; all 26 addressed medical home implementation challenges. Survey rates were 63% for baseline and 48% for both follow-up waves. Age was associated with lower burnout among PCPs (p = .039) and male PCPs had higher satisfaction (p = .037). Controlling for practice and PCP/staff characteristics, burnout increased by 5 points for PCPs in comparison practices (p = .024) and decreased by 1.4 points for early and 6.8 points (p = .039) for the late EBQI practices. CONCLUSIONS: Engaging PCPs and staff in EBQI reduced burnout over time during medical home transformation.


Assuntos
Esgotamento Profissional/psicologia , Pessoal de Saúde/psicologia , Satisfação no Emprego , Moral , Assistência Centrada no Paciente , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade , Adulto , Fatores Etários , Gerentes de Casos , Medicina Baseada em Evidências , Feminino , Educadores em Saúde , Humanos , Ciência da Implementação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem , Enfermeiras e Enfermeiros , Assistentes Médicos , Médicos de Atenção Primária , Estados Unidos , United States Department of Veterans Affairs
10.
LGBT Health ; 5(5): 303-311, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29979640

RESUMO

PURPOSE: This study aimed to compare experiences related to healthcare of LGBT women and non-LGBT women in a sample of routine users of Veterans Health Administration (VHA) primary care services and examine the impact of those experiences on delaying or missing appointments for VHA care. METHODS: Women veterans (N = 1391) who had at least three primary care visits in the previous year at 12 VHA facilities were surveyed by phone in January-March 2015 in a baseline wave of a cluster-randomized quality improvement trial. The majority identified as non-LGBT (1201; 85.6%) with 190 (14.4%) women identified as LGBT, based on items measuring sexual orientation and gender identity. RESULTS: In models controlling for demographics, health status, and positive trauma screens, LGBT identity was predictive of women veterans experiencing harassment from male veterans at VHA in the past 12 months, as well as feeling unwelcome or unsafe at their VHA. Compared with non-LGBT women veterans, LGBT women veterans attributed missing needed care more often in the previous 12 months to concerns about interacting with other veterans. Participant descriptions of harassment indicated that male veterans' comments and actions were distressing and influenced LGBT women's healthcare accessing behavior. CONCLUSIONS: Compared with non-LGBT women, LGBT women were more likely to report harassment and feeling unwelcome at VHA. Some LGBT women reported delaying or missing needed care, primarily due to concerns about interacting with other veterans. Additional work is necessary to help LGBT women veterans feel safe and welcome at VHA facilities and, thereby, reduce barriers to LGBT women veterans accessing needed care.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Veteranos/psicologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estatística & dados numéricos , Adulto Jovem
11.
Womens Health Issues ; 28(5): 430-438, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30017475

RESUMO

BACKGROUND: Identifying factors influencing patient experience and communication with their providers is crucial for tailoring comprehensive primary care for women veterans within the Veterans Health Administration. In particular, the impact of mental health (MH) conditions that are highly prevalent among women veterans is unknown. METHODS: From January to March 2015, we conducted a cross-sectional survey of women veterans with three or more primary care and/or women's health visits in the prior year at 12 Veterans Health Administration sites. Patient measures included ratings of provider communication, trust in provider, and care quality; demographics, health status, health care use; and brief screeners for symptoms of depression, anxiety, and posttraumatic stress disorder. We used multivariate models to analyze associations of patient ratings and characteristics. RESULTS: Among the 1,395 participants, overall communication ratings were high, but significant variations were observed among women screening positive for MH conditions. In multivariate models, high communication ratings were less likely among women screening positive for multiple MH conditions compared with patients screening negative (odds ratio, 0.43; p < .001). High trust in their provider and high care ratings were significantly less likely among women with positive MH screens. Controlling for communication, the effect of MH on trust and care ratings became less significant, whereas the effect of communication remained highly significant. CONCLUSIONS: Women veterans screening positive for MH conditions were less likely to give high ratings for provider communication, trust, and care quality. Given the high prevalence of MH comorbidity among women veterans, it is important to raise provider awareness about these differences, and to enhance communication with patients with MH symptoms in primary care.


Assuntos
Comunicação , Saúde Mental , Satisfação do Paciente , Relações Profissional-Família , Qualidade da Assistência à Saúde , Confiança , Veteranos/psicologia , Adolescente , Adulto , Idoso , Ansiedade/diagnóstico , Transtornos de Ansiedade/diagnóstico , Estudos Transversais , Depressão/diagnóstico , Feminino , Nível de Saúde , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos , Saúde da Mulher
13.
Med Care ; 56(6): 491-496, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29683867

RESUMO

BACKGROUND: The Patient-centered Medical Home (PCMH) uses team-based care to improve patient outcomes, including satisfaction. The quality of patients' communication with their primary care providers (PCPs) is a key determinant of patient satisfaction. A shift to team-based care could disrupt the therapeutic relationship between patients and their PCPs and reduce patient satisfaction if communication and coordination among primary care team members is poor. Little is known about the relationship between intrateam communication within a PCMH and patient satisfaction with PCPs, and whether patient-provider communication might mediate this relationship. OBJECTIVES: To examine the relationship between intrateam communication in a PCMH and patients' satisfaction with assigned PCPs, and whether patient-provider communication mediates this relationship. RESEARCH DESIGN: Cross-sectional surveys of Veterans Health Administration PCPs (2011-2012, n=149) matched with their assigned patients' surveys (n=3329). Mediation analyses using a nested data structure, controlling for patient and provider characteristics. MEASURES: Patient satisfaction with PCPs, patient-reported patient-provider communication, and PCP-reported intrateam communication within the PCMH. RESULTS: Intrateam communication and patient-provider communication were independently associated with patients' satisfaction with their PCPs. Patient-provider communication mediated 56% of the association between intrateam communication and patient satisfaction. Better intrateam communication combined with better patient-provider communication predicted high satisfaction (81%), compared with poor intrateam communication and poor patient-provider communication (22%). CONCLUSIONS: PCMH environments with better communication among team members are likely to experience better patient-provider communication and high patient satisfaction. PCMH practices with low ratings of patient satisfaction may need to look beyond individual PCPs to communication within and across teams.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Relações Profissional-Paciente , Atitude do Pessoal de Saúde , Comunicação , Estudos Transversais , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos e Questionários
14.
Womens Health Issues ; 28(3): 267-272, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29475630

RESUMO

BACKGROUND: Food insecurity has been associated with worse health outcomes in the civilian population. Male veterans of the Gulf Wars have been shown to have a higher prevalence of food insecurity than similarly situated civilians. Women veterans have more risk factors for food insecurity, relative to male veterans, yet little is known about the prevalence of food insecurity in this cohort. METHODS: We used the Women Veterans' Health Utilization and Experience Survey for this analysis. Our study population consisted of women veterans who had at least three primary care or women's health visits to 1 of 12 Veteran's Health Administration health care facilities from December 2013 to November 2014. Multiple logistic regression was used to examine the relationship between food insufficiency (an inadequate amount of food intake owing to a lack of money or resources), delayed/missed care, anxiety, depression, and self-reported fair to poor health, controlling for race/ethnicity, marital status, and employment status. RESULTS: The prevalence of food insufficiency among women veterans was 27.6%. Being food insufficient was associated with 16.4, 15.4, 14.9, and 12.1 percentage point increases in the probability of delayed/missed care, screening positive for anxiety, screening positive for depression, and reporting fair to poor health, respectively (p < .05). CONCLUSIONS: The prevalence of food insufficiency in this cohort was associated with delayed access to health care and worse health outcomes. Interventions addressing Veterans Administration access and health outcomes will need to examine the potential role of food insufficiency.


Assuntos
Abastecimento de Alimentos/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Saúde dos Veteranos/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Ansiedade/epidemiologia , Depressão/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicologia
15.
Womens Health Issues ; 28(2): 165-171, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29339012

RESUMO

BACKGROUND: Primary care teams can facilitate access to care by helping patients to determine whether and when care is needed, and coordinating care across multiple clinicians and settings. Appointment availability metrics may or may not capture these contributions, but patients' own ratings of their access to care provide an important alternative view of access that may be more closely related to these key functions of care teams. PROCEDURES: We used a 2015 telephone survey of 1,395 women veterans to examine associations between key care team functions and patient-rated access to needed care. The care team functions were care coordination, in-person communication (between patient and care team), and phone communication (timely answers to health questions). We controlled for sociodemographics, health status, care settings, and other experience of care measures. KEY FINDINGS: Overall, 74% of participants reported always or usually being able to see a provider for routine care, and 68% for urgent care. In adjusted analyses, phone communication was associated with better ratings of access to routine care (odds ratio [OR], 4.31; 95% CI, 2.65-6.98) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Care coordination was also associated with better ratings of access to routine care (OR, 1.66; 95% CI, 1.01-2.74) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Associations with in-person communication were not significant. CONCLUSIONS: Access, communication, and care coordination are interrelated. Approaches to improving access may prove counterproductive if they compromise the team's ability to coordinate care, or diminish the team's role as a primary point of contact for patients.


Assuntos
Agendamento de Consultas , Acessibilidade aos Serviços de Saúde/organização & administração , Assistência Centrada no Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Veteranos , Adulto , Comunicação , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Assistência Centrada no Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos
16.
Womens Health Issues ; 27(5): 586-591, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28754476

RESUMO

BACKGROUND: Military sexual trauma (MST) and/or intimate partner violence (IPV) are common experiences in the growing group of women veterans using the Veterans Health Administration health care system. And even though MST screening is closely monitored at the facility level, little is known about individual primary care provider (PCP) behavior with regard to screening women for MST and IPV. OBJECTIVES: To understand how PCP experiences and beliefs regarding women's health care influence PCP-reported screening for MST and IPV. RESEARCH DESIGN AND PARTICIPANTS: We administered a cross-sectional online survey from September 2014 through April 2015 (supplemented by a mailed survey between April and May 2015) to 281 PCPs in 12 Veterans Health Administration medical centers. MEASURES AND ANALYSIS: Surveys measured PCP-reported screening frequency for MST and IPV, experience with women veterans, self-efficacy, gender-sensitive beliefs, and perceived barriers to providing comprehensive care for women. We used multivariable ordered logistic regression analysis to identify correlates of screening, weighted for nonresponse and adjusted for clustering. RESULTS: Ninety-four PCPs (34%) completed the survey. Being a designated women's health provider (p < .05) and stronger self-efficacy beliefs about screening women for MST (p < .001) were associated with reporting more frequent screening for MST. Being a designated women's health provider (p < .01), seeing women patients at least once per week (p < .001), and self-efficacy beliefs about screening women for IPV (p < .001) were associated with reporting more frequent screening for IPV. CONCLUSIONS: Veterans Health Administration initiatives to enhance PCP opportunities to screen women veterans for trauma and to strengthen self-efficacy beliefs about comprehensive women's health care may increase screening of women veterans for MST and IPV.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Violência por Parceiro Íntimo/psicologia , Atenção Primária à Saúde , Maus-Tratos Conjugais/diagnóstico , Veteranos/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Maus-Tratos Conjugais/psicologia , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estatística & dados numéricos , Saúde dos Veteranos , Saúde da Mulher
17.
Womens Health Issues ; 27(2): 221-227, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28087130

RESUMO

BACKGROUND: Despite the growing demand for health care among women veterans in the Veterans Health Administration (VHA), little is known about the perspectives of primary care providers (PCPs) and other primary care staff about the care they provide to women veterans. We sought to understand whether barriers to, attitudes about, and practices in caring for women veterans were associated with two measures of implementation of the VHA patient-centered medical home for women veterans (self-efficacy and satisfaction). METHODS: We administered a cross-sectional survey by Internet from September 8, 2014, through April 27, 2015 (and by mail from December 16, 2014, through June 18, 2015) to all PCPs and affiliated primary care staff in 12 VHA medical centers. We used descriptive and bivariate analyses to characterize their barriers, attitudes, and practices regarding care for women veterans; and ordinary least squares regression to identify associations with satisfaction and self-efficacy regarding medical home implementation for women veterans among members of a VHA patient-centered medical home teamlet for women patients. RESULTS: Of 775 surveys sent, 288 were completed (94 PCPs and 194 staff) for a response rate of 37% (33% for PCPs; 39% for staff). On average, providers had one female patient for every five patients in their panels. Lower perceived barriers, higher gender-sensitive attitudes, and being a PCP were significantly associated with satisfaction and self-efficacy of patient-centered medical home for women patients. CONCLUSIONS: Training efforts focused on eliminating perceived barriers and strengthening positive attitudes toward women may be more successful than changing women's health practice characteristics alone.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde , Assistência Centrada no Paciente/organização & administração , Veteranos , Serviços de Saúde da Mulher/organização & administração , Adulto , Continuidade da Assistência ao Paciente , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs , Saúde da Mulher , Serviços de Saúde da Mulher/estatística & dados numéricos
18.
Womens Health Issues ; 27(2): 214-220, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28063848

RESUMO

BACKGROUND: The Veterans Health Administration (VA) Patient Aligned Care Team (PACT) initiative aims to ensure that all patients receive care consistent with medical home principles. Women veterans' unique care needs and minority status within the VA pose challenges to delivery of equitable, comprehensive primary care for this population. Currently, little is known about whether and/or how PACT should be tailored to better meet women veterans' needs. METHODS: In 2014, we conducted semistructured interviews with 73 primary care providers and staff to examine facilitators and barriers encountered in providing PACT-principled care to women veterans. Respondents were located in eight VA medical centers in eight different states across the United States. RESULTS: Respondents perceived PACT as improving continuity of care for patients and as increasing ability of nursing staff to practice at the top of their license. However, the implementation of core medical home features and team huddles was inconsistent and varied both within and across medical centers. Short staffing, inclusion of part-time providers on teams, balancing performance requirements for continuity and same-day access, and space constraints were identified as ongoing barriers to PACT implementation. Challenges unique to care of women veterans included a higher prevalence of psychosocial needs, the need for specialized training of primary care personnel, and short staffing owing to additional sharing of primary care support staff with specialist providers. CONCLUSION: Providers and staff face unique challenges in delivering comprehensive primary care to women veterans that may require special policy, practice, and management action if benefits of PACT are to be fully realized for this population.


Assuntos
Atitude do Pessoal de Saúde , Equipe de Assistência ao Paciente , Assistência Centrada no Paciente/organização & administração , Veteranos , Serviços de Saúde da Mulher/organização & administração , Continuidade da Assistência ao Paciente , Feminino , Humanos , Entrevistas como Assunto , Enfermeiras e Enfermeiros , Médicos de Atenção Primária , Pesquisa Qualitativa , Estados Unidos , United States Department of Veterans Affairs
19.
Implement Sci ; 11(1): 101, 2016 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-27435723

RESUMO

BACKGROUND: The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT). METHODS/DESIGN: EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. DISCUSSION: Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02039856.


Assuntos
Medicina Baseada em Evidências/métodos , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Melhoria de Qualidade , Saúde dos Veteranos/normas , Análise por Conglomerados , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Feminino , Humanos , Estados Unidos , United States Department of Veterans Affairs , Veteranos
20.
Med Care ; 53(3): 253-60, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25675403

RESUMO

OBJECTIVE: Transformation of primary care to new patient-centered models requires major changes in healthcare organizations, including interprofessional expectations and organizational policies. Emotional exhaustion (EE) among workers can accompany major organizational change, threatening its success. Yet little guidance exists about the magnitude of associations with EE during primary care transformation. We assessed EE during the initial phase of national primary care transformation in the Veterans Health Administration. RESEARCH DESIGN: Cross-sectional online surveys of primary care clinicians (PCCs) and staff in 23 primary care clinics within 5 healthcare systems in 1 veterans administration administrative region. We used descriptive, bivariate, and multivariable analyses adjusted for clinic membership and weighted for nonresponse. PARTICIPANTS: 515 veterans administration employees (191 PCCs and 324 other primary care staff). MEASURES: Outcome is the EE subscale of the Maslach Burnout Inventory. Predictors include clinic characteristics (from administrative data) and self-reported efficacy for change, experiences with transformation, and perspectives about the organization. RESULTS: The overall response rate was 64% (515/811). In total, 53% of PCCs and 43% of staff had high EE. PCCs (vs. other primary care staff), female (vs. male), and non-Latino (vs. Latino) respondents reported higher EE. Respondents reporting higher efficacy for change and participatory decision making had lower EE scores, adjusting for sex and race. CONCLUSIONS: Recognition by healthcare organizations of the potential for clinician and staff EE during primary care transformation is critical. Methods for reducing EE by increasing clinician and staff change efficacy and opportunities to participate in decision making should be considered, with attention to PCCs, and women.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Hospitais de Veteranos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistência Centrada no Paciente/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Atenção Primária à Saúde/organização & administração , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/organização & administração
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