Improving care for women Veterans with substance use disorders

描述(由申请人提供)： 背景：物质使用障碍(SUD)--与滥用或依赖一系列物质相一致的药物使用疾病--是退伍军人常见且代价高昂的心理健康问题。研究表明，妇女与男子在性功能障碍的模式、服务的使用以及治疗和结果的决定因素方面有所不同。尽管退伍军人管理局的SUD护理重点放在男性身上，他们在SUD治疗中占退伍军人总数的96%，但女性退伍军人是一个特别脆弱的群体，具有明显的治疗需求和障碍。与男性退伍军人相比，女性退伍军人有更高的其他精神疾病，包括创伤后应激障碍、军人性创伤(MST)、躁郁症/精神障碍和情绪障碍，伴发的PTSD或MST的发生需要在私人和安全的SUD治疗环境中评估和适应妇女的需求。尽管退伍军人管理局要求“性别意识护理”，但妇女保健诊所以外的大多数退伍军人管理局提供者几乎没有或根本没有为女性退伍军人提供服务的经验。女性退伍军人在以男性为主的退伍军人治疗环境中可能会遇到困难。目的：拟议的CDA项目的目标是开发必要的基础证据，以改善退伍军人获得最佳的、对性别问题有敏感认识的SUD护理的机会。为了实现这一目标，我将检查患者、提供者和组织因素，这些因素促进或阻碍了适当和 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。第一个是对相关组织和患者层面数据的二次分析，将描述妇女参与SUD治疗(启动、参与和药物治疗)的模式和决定因素以及退伍军人管理局各机构的患者结果。第二项将包括制定和管理第一份关于退伍军人退伍军人保健组织结构的调查。调查数据将与患者水平的数据联系起来，以确定女性SUD治疗结构对女性退伍军人的治疗参与度和患者结果的影响。第三个项目是深入的定性研究，从女性VA SUD患者那里了解她们在VA SUD护理方面的经验，以及她们对治疗障碍、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的、对性别敏感的护理是退伍军人管理局的目标，但在退伍军人管理局妇女在哪里以及如何获得SUD护理方面存在基本的信息差距。此外，几乎没有开展工作来确定能够最好地解决退伍军人妇女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，为女性退伍军人提供最佳的、对性别问题有敏感认识的sud护理。 公共卫生相关性： 为患有物质使用障碍(SUD)的退伍军人提供最佳的、以患者为中心的护理，需要关于她们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，改善向女性退伍军人提供对性别敏感的SuD护理。计划中的培训活动将使我获得使用退伍军人管理局数据、开发组织调查和建设进行定性研究的能力的经验。这项计划中的研究将首次调查退伍军人在退伍军人中接受SUD治疗的模式、医疗专业和患者分组；SUD治疗对妇女结局的影响；退伍军人中妇女SUD护理的详细结构；以及妇女对VA SUD护理的质量体验。这项研究直接解决了退伍军人事务部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、以证据为基础的专科护理的努力。

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.