Improving care for women Veterans with substance use disorders

描述（由申请人提供）： 背景资料：物质使用障碍（SUD）-与滥用或依赖一系列物质一致的药物使用疾病-是退伍军人中常见且昂贵的心理健康状况。研究表明，妇女与男子在未成年人吸毒模式、服务使用情况以及治疗和结果的决定因素方面存在差异。虽然在弗吉尼亚州的SUD护理的重点一直是谁占96%的退伍军人在SUD治疗的男性，女性退伍军人代表一个特别脆弱的群体与独特的需求和治疗障碍。女性退伍军人有更高的其他精神疾病的发病率，包括创伤后应激障碍，军事性创伤（MST），双相/精神障碍，情绪障碍比他们的男性同行，并伴随创伤后应激障碍或MST的发生需要评估和适应妇女的需要在一个私人和安全的SUD治疗环境。尽管退伍军人事务部要求"性别意识护理"，但妇女保健诊所以外的大多数退伍军人事务部提供者很少或根本没有为退伍军人妇女提供服务的经验。女性退伍军人可能在以男性为主的VA治疗环境中遇到困难。目的：拟议的CDA项目的目标是开发所需的基础证据，以改善退伍军人获得最佳的，对性别敏感的SUD护理。为了实现这一目标，我将研究患者，提供者和组织因素，促进或阻碍提供适当的， 使用混合方法对女退伍军人进行有效护理。方法：拟议的CDA研究计划将包括3个独立的项目。第一，二次分析的链接组织和患者层面的数据，将描述的模式和妇女的SUD治疗的参与（启动，参与和药物治疗）和患者的结果跨VA设施的决定因素。第二个项目将包括制定和管理对退伍军人事务部妇女保健组织结构的第一次调查。调查数据将与患者层面的数据相关联，以确定女性SUD治疗结构对女性退伍军人治疗参与和患者结局的影响。第三个项目将是一项深入的定性研究，以了解女性VA SUD患者的VA SUD护理经验以及他们对治疗障碍，偏好和需求的看法。拟议的CDA职业计划建立在我强大的流行病学和生物统计学培训的基础上，同时确保在使用VA数据源，卫生服务研究设计，物质使用障碍理论，心理健康中的性别问题，定性研究，组织调查设计和实施科学方面的教育，培训和指导。结论：为患有SUD的女性退伍军人提供以患者为中心，对性别敏感的护理是VA的目标，但在VA中妇女在何处以及如何获得SUD护理方面存在根本的信息差距。此外，几乎没有做什么工作来确定能够最好地解决女退伍军人的具体需求和治疗障碍的护理特点。拟议的研究将解决这些知识差距，为随后的目标努力铺平道路，为退伍军人提供最佳的，对性别敏感的SUD护理。 公共卫生相关性： 努力提供最佳的，以病人为中心的护理与物质使用障碍（SUD）的女性退伍军人需要他们的具体治疗需求和障碍的信息。拟议的CDA将使我能够建立一个职业生涯，改善对妇女退伍军人的性别敏感的SUD护理。计划中的培训活动将使我获得使用VA数据、开发组织调查和建立进行定性研究的能力的经验。计划中的研究将首次调查女性退伍军人SUD治疗在VA环境，医学专业和患者亚组中的模式; SUD治疗对女性结局的影响; VA中女性SUD护理的详细结构;以及女性VA SUD护理的定性经验。这项研究直接解决了VA HSR & D在妇女健康研究中的优先事项，并支持SUD-QUERI促进以患者为中心的循证专科护理的努力。

DESCRIPTION (provided by applicant): Background: Substance use disorders (SUD)-drug use illnesses consistent with abuse or dependence of a range of substances-are common and costly mental health conditions among Veterans. Research has demonstrated that women differ from men in their patterns of SUD and in their use of services and determinants of treatment and outcomes. Although the emphasis of SUD care in the VA has been on the men who make up 96% of Veterans in SUD treatment, women Veterans represent a particularly vulnerable group with distinct needs and barriers to treatment. Women Veterans have higher rates of other psychiatric conditions, including PTSD, military sexual trauma (MST), bipolar/psychotic disorder, and mood disorders than do their male counterparts, and the occurrence of concomitant PTSD or MST requires assessing and accommodating women's needs in a private and safe SUD treatment environment. Despite VA requirements for "gender aware care", most VA providers outside of women's health clinics have little or no experience delivering services to women Veterans. Women Veterans may have difficulty in the predominantly-male VA treatment environment. Purpose: The goal of the proposed CDA project is to develop the foundational evidence needed to improve women Veterans' access to optimal, gender-sensitive SUD care. To accomplish this goal, I will examine patient, provider, and organizational factors that foster or hinder the delivery of appropriate and effective care for women Veterans using mixed methods. Methods: The proposed CDA research plan will comprise 3 separate projects. The first, a secondary analysis of linked organizational- and patient-level data, will describe the patterns and determinants of women's SUD treatment involvement (initiation, engagement, and pharmacotherapy) and patient outcomes across VA facilities. The second will include the development and administration of the first survey of the organizational structure of women Veterans' VA SUD care. The survey data will be linked to patient-level data to determine the impact of women's SUD treatment structure on women veterans' treatment involvement and patient outcomes. The third project will be an in-depth qualitative study to learn from women VA SUD patients their experiences with VA SUD care and their perceptions of treatment barriers, preferences, and needs. The proposed CDA career plan builds on my strong epidemiology and biostatistics training while ensuring education, training and mentorship in the use of VA data sources, health services research design, the theory of substance use disorder, gender issues in mental health, qualitative research, organizational survey design, and implementation science. Conclusions: Providing patient-centered, gender-sensitive care for women Veterans with SUD is a VA goal, but there are fundamental information gaps on where and how women access SUD care in the VA. Moreover, little work has been done to determine the features of care that can best address women Veterans' specific needs and treatment barriers. The proposed research will address these knowledge gaps, paving the way to subsequent target efforts to provide women Veterans optimal, gender-sensitive SUD care. PUBLIC HEALTH RELEVANCE: Efforts to deliver optimal, patient-centered care for women Veterans with substance use disorder (SUD) require information on their specific treatment needs and barriers. The proposed CDA will allow me to build a career improving the delivery of gender-sensitive SUD care to women Veterans. The planned training activities will give me experience working with VA data, developing organizational surveys, and building the capacity to conduct qualitative research. The planned research will investigate for the first time the patterns of women Veterans' SUD treatment across VA settings, medical specialties, and patient subgroups; the impact of SUD treatment on women's outcomes; the detailed structure of women's SUD care in the VA; and women's qualitative experiences of VA SUD care. This research directly addresses VA HSR&D priorities in Women's Health Research and supports the efforts of the SUD-QUERI to promote patient-centered, evidence-based specialty care.