欢迎环境是否会影响女性退伍军人的初级保健体验?

IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Womens Health Issues Pub Date : 2024-09-01 DOI:10.1016/j.whi.2024.07.002
Danielle E. Rose PhD, MPH , Melissa M. Farmer PhD , Sabine M. Oishi PhD, MSPH , Ruth S. Klap PhD , Bevanne A. Bean-Mayberry MD, MHS , Ismelda Canelo MPA , Donna L. Washington MD, MPH , Elizabeth M. Yano PhD, MPH
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引用次数: 0

摘要

背景:温馨的环境可能会影响患者的护理体验,对于代表性不足的群体,例如退伍军人健康管理局设施中的女性退伍军人,她们仅占患者总数的 8-10%,这一点可能尤为重要。要确保为女性退伍军人营造一个温馨的环境所面临的挑战可能包括来自男性退伍军人、工作人员或志愿者的不受欢迎的评论,以及在退伍军人医疗机构内外感到不安全。我们评估了与性别相关的护理环境问题报告与患者报告结果之间的关联:我们将全国女性退伍军人(n = 4961)的患者报告结果与女性退伍军人项目经理对退伍军人事务部设施中与性别相关的护理环境问题的报告(n = 127,2016-2017 年)进行了合并。我们进行了多层次的双变量逻辑回归,以评估女性退伍军人项目管理人员报告的大型/极端问题与女性退伍军人对初级医疗体验(就医途径、协调性、全面性、提供者沟通以及对初级医疗提供者的总体评价)最佳评价的可能性之间的关联。我们对患者、医疗机构和地区层面的特征以及退伍军人医疗机构内的患者聚类进行了调整,并应用设计权重来解决患者数据中的非响应偏差。女退伍军人的回复率为 40%,女退伍军人项目经理的回复率为 90%:很少(主要结论:确保一个温馨的环境可以改善女性退伍军人的初级保健体验。
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Does a Welcoming Environment Influence Women Veterans’ Primary Care Experiences?

Background

A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8–10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes.

Procedures

We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016–2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans’ optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers.

Main Findings

Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal.

Principal Conclusions

Ensuring a welcoming environment may improve women veterans' primary care experiences.

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来源期刊
CiteScore
4.50
自引率
6.20%
发文量
97
审稿时长
32 days
期刊介绍: Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.
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