Care for Women Veterans with Hepatitis C Virus Infection

描述(由申请人提供)： 背景-CHC治疗与健康方面的重大进展有关，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，因为在包括慢性丙型肝炎在内的几种疾病上，女性的保健需求与男性不同，治疗慢性丙型肝炎的障碍也可能因性别而异。患有CHC的妇女有更多的心理健康合并症--这是抗病毒治疗的主要可修改障碍。女性自我报告的军人性创伤的比例也要高得多，这往往会导致心理健康问题。女性在VHA的护理经历和她们对护理的看法也与男性截然不同。最近VHA中妇女比例的增加和更有效的CHC治疗的可获得性，需要特别关注可能导致患有CHC的女性退伍军人错过治疗机会的可改变因素。目标-拟议的项目将使用混合方法设计来(1)通过分别看CHC专家和接受抗病毒治疗来衡量获得和接受CHC护理的性别差异，(2)确定CHC女性退伍军人获得和接受CHC护理的预测因素，(3)在VHA方法中描述妇女在获得CHC护理和接受CHC治疗方面的经历-为了实现目标1，我们将使用现有的结构化自动化数据来检查全国CHC退伍军人队列中看CHC专家和接受抗病毒治疗的比率(N&>T；6000名妇女和GT；在2002-2012年间登记参加VHA的150,000名男性)，以检查性别对这些终点的影响。为了达到目标2，我们将进行多水平回归分析，以确定影响患有慢性丙型肝炎的女性退伍军人获得和接受丙型肝炎治疗的关键预测因素(特别是高影响、可修改的因素)。我们还将在患有慢性丙型肝炎的男性退伍军人的平行队列中建立单独的多水平回归，以用于基准。为了达到目标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地点患有CHC的退伍军人进行深入的叙述性采访，她们要么1)没有看过CHC专家，2)看过一次专家但没有完成他们的CHC临床评估，或者3)表示有兴趣或接受过CHC治疗。我们期望这三个患者群体的回应将提供补充的洞察，从女性退伍军人的角度，了解患者在从事CHC护理时考虑(或可能应该或可能已经考虑)的因素，以及从女性退伍军人的角度来看，这种参与质量护理的公认障碍和促进者。

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.