Care for Women Veterans with Hepatitis C Virus Infection

描述（由申请人提供）： 背景- CHC治疗与健康方面的主要收益相关，包括降低进展为终末期肝病和肝细胞癌的风险。我们对VHA中CHC护理的大部分知识都是基于对男性的研究。这是一个问题，因为妇女的保健需要与男子的不同，包括社区卫生服务和社区卫生服务治疗的障碍也可能因性别而异。患有CHC的女性有更多的精神健康合并症-抗病毒治疗的主要可改变障碍。女性自我报告的军事性创伤也要高得多，这往往会导致心理健康问题。妇女的护理经历和她们对VHA护理的看法也与男子不同。最近在VHA和更有效的CHC治疗的可用性的妇女比例的增加，需要一个具体的重点可修改的因素，可能会导致女性退伍军人与CHC错过治疗机会。目标-拟议项目将采用混合方法设计，以（1）分别通过看CHC专家和接受抗病毒治疗来检查获得和接受CHC护理的性别差异，（2）确定患有CHC的退伍军人获得和接受CHC护理的预测因素，（3）在VHA方法中描述妇女获得CHC护理和接受CHC治疗的经历-为了实现目标1，我们将利用现有的结构化自动化数据来检查全国患有CHC的退伍军人队列中CHC专家的就诊率和抗病毒治疗的接受率（n> 6，000名女性和> 150，000名男性），研究性别对这些终点的影响。为了实现目标2，我们将进行多水平回归分析，以确定获得和接受女性退伍军人CHC治疗的关键预测因素（特别是高影响力，可修改的因素）。我们还将在CHC男性退伍军人的平行队列中构建单独的多水平回归，以进行基准测试。为了实现目标3，我们将进行一项定性研究，包括对3个地理位置不同的VHA研究中心的女性退伍军人CHC进行深入的叙述性访谈，这些退伍军人1）没有看过CHC专家，2）看过一次专家但尚未完成其CHC的临床评价，或3）表示有兴趣或接受CHC治疗。我们希望这3个患者群体的反应将提供补充性的见解，患者考虑（或可能应该或可能考虑）在从事CHC护理的因素，以及从女性退伍军人的角度来看，这种参与优质护理的感知障碍和促进因素。

DESCRIPTION (provided by applicant): Background - CHC treatment is associated with major gains in health, including reduced risk of progression to end-stage liver disease and hepatocellular carcinoma. Most of our knowledge of CHC care in the VHA is based on studies of men. This is a problem because women's health-care needs differ from men's for several conditions including CHC and barriers to CHC treatment are also likely to vary by gender. Women with CHC have more mental health comorbidities-the leading modifiable barrier to antiviral treatment. Women also have much higher self-reported military sexual trauma, which often leads to mental health issues. Women's care experiences and their perception of care in the VHA are also distinct from those of men. The recent increases in the proportion of women in the VHA and the availability of more effective CHC treatment necessitate a specific focus on modifiable factors that may be contributing to missed treatment opportunities in women Veterans with CHC. Objectives - The proposed project will use a mixed methods design to (1) examine gender differences in access to and receipt of CHC care measured by seeing a CHC specialist and receipt of antiviral treatment, respectively, (2) identify predictors of access to and receipt of CHC care in women Veterans with CHC, (3) characterize women's experiences with accessing CHC care and receiving CHC treatment in the VHA Methods - To achieve Aim 1, we will use existing structured automated data to examine the rate of seeing CHC specialist and receipt of antiviral treatment in a national cohort of Veterans with CHC (n>6000 women and >150,000 men) who are enrolled in the VHA during 2002-2012 to examine the effect of gender on these endpoints. To achieve Aim 2, we will conduct multi-level regression analyses to identify key predictors (especially high-impact, modifiable factors) of access to and receipt of CHC treatment among women Veterans with CHC. We will also construct separate multi-level regression in a parallel cohort of male Veterans with CHC for purposes of benchmarking. To achieve Aim 3, we will conduct a qualitative study consisting of in-depth narrative interviews with women Veterans with CHC at 3 geographically distinct VHA sites who have either, 1) not seen a CHC specialist, 2) seen a specialist once but have not completed clinical evaluation of their CHC, or 3) expressed interest in or received CHC treatment. We expect that the responses from these 3 patient groups will provide complementary insight into the factors that patients consider (or potentially should or could have considered) in engaging in CHC care as well as the perceived barriers to and facilitators of such engagement in quality care from the woman veterans' perspective.