Critical Topics in Military Women s Health: Women Veteran s Health AMSUS Annual Meeting, November, 2018 Sally Haskell, MD, MS Deputy Chief Consultant, Women s Health Services (WHS) Veterans Health Administration November 29, 2018
Women in the Military: A Growing Trend Source: America s Women Veterans, National Center for Veterans Analysis and Statistics, Nov. 23, 2011. Veterans: Military Service History and VA Benefits Utilization Statistics, Department of 3, 2011; http://www.va.gov/vetdata/docs/specialreports/final_womens_report_3_2_12_v_7.pdf 2
# Women Veteran Patients Number Of Women Veteran VHA Patients In Each Year, Fiscal Year(FY) 2000-FY 2017 The number of women Veterans using VHA services has tripled since 2000, growing from 159,810 in FY00 to 484,317 in FY17, representing a 203% increase over 17 years. 600,000 500,000 439,791 484,317 400,000 300,000 231,907 317,122 200,000 159,810 100,000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 3
# Women Veteran Patients Age Distribution of Women Veteran Patients FY00 and FY17 14,000 FY00 12,000 FY17 10,000 8,000 6,000 4,000 2,000 0 15 25 35 45 55 65 75 85 95 105 Cohort: Women Veteran VHA patients with non-missing ages 18-110 years (inclusive) in FY00 and FY17. Women in FY00: N=159,553; FY17: N=484,156. Source: WHEI Master Database, FY00-FY17 4
Race/Ethnicity Distribution of Women and Men Veteran Patients by Age, FY17 Cohort: Women and men Veteran VHA patients with non-missing ages 18-110 years (inclusive) in FY17. Women: N=484,156; Men: N=5,523,491. Source: WHEI Master Database, FY17 (using OMOP and Vital Status File data to identify race/ethnicity) 5
Domain Frequencies Among Women Veteran Patients Domain % Infectious Disease 27.5 Endocrine/Metabolic/Nutritional 51.2 Cardiovascular 36.1 Respiratory 32.3 Gastrointestinal 31.6 Urinary 15.0 Reproductive Health 31.2 Breast 6.8 Cancer 5.1 Hematologic/Immunologic 9.6 Musculoskeletal 58.7 Neurologic 31.8 Mental Health/Substance Use Disorder 48.4 Sense Organ 33.3 Dental 10.5 Dermatologic 22.6 Other 52.1 Cohort: Women Veteran VHA patients. Women in FY00: N=159,810; FY15: N=439,791. Source: WHEI Master Database, FY00-FY15 FY15 N=439,791 6
Top 20 Conditions in Women Veteran VHA Patients, FY00 and FY15 FY15 N=439,791 Rank Condition % 1 Hypertension 27.2 2 Depression, Possible - Other 26.7 3 Lipid Disorders 25.2 4 Joint Disorders - Lower Extremity 23.8 5 Spine Disorders - Lumbosacral 22.8 6 Dermatologic Disorders - Other 20.3 7 Anxiety Disorders - Other 19.7 8 Overweight/Obesity 19.6 9 Refraction Disorders 18.5 10 Posttraumatic stress disorder (PTSD) 18.4 11 Musculoskeletal Conditions - Other 18.1 12 Headache 17.3 13 Eye Disorders - Other 16.3 14 Esophageal Disorders 16.0 15 Major Depressive Disorder 14.2 16 Joint Disorders - Unspecified or Multiple Joints 13.8 17 Tobacco Use Disorder 13.1 18 Thyroid Disorders 13.0 19 Allergic and Other Chronic Sinusitis/Rhinitis 12.7 20 Spine Disorders - Other/Unspecified 12.6 * Indicates an increase of 5 or more in rank order from FY00. Cohort: Women Veteran VHA patients. Women in FY00: N=159,810; FY15: N=439,791. Source: WHEI Master Database, FY00-FY15 7
Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Medical Diagnoses of 149,452 Women Veterans seen in VA (2002-2015,Quarter 3) Musculoskeletal (MSK) 62% Mental Disorders 57% Nervous System/Sense Organs 51% Genitourinary System 46% Digestive System (Dental) 41% Endocrine System 40% Respiratory 38% Skin Diseases 32% Injury/Poisoning 31% Infectious/Parasitic Diseases 23% Circulatory 21% 8
Total VHA Primary Care Encounters Among Women and Men Veteran VHA Patients, FY17 Cohort: Women and men Veteran VHA patients in FY17. Women: N=484,317; Men: N=5,523,756. Source: WHEI Master Database, FY17 9
VA Provides Full Continuum Of Health Care For Enrolled Women Veterans Comprehensive Primary Care (acute care, chronic illness and gender-specific care from a single provider) Routine Gynecological care Mental Health Disease Management, Prevention and Screening Emergency Care Infertility Care Maternity Care (Newborn care up to 7 days) Specialty Care Hospice/Palliative Care Long-Term Care Services and Supports 10
VHA Services for Women Veterans VHA expanding services and sites of care: Increasing primary care providers trained to care for women: Over 3,400 across country Gynecologists on site: 196 across country Mammography on site: 60 sites across country and more coming Telehealth services: tele-gynecology, tele-mental health, tele-wellness 11
Delivery of Comprehensive Primary Care Complete primary care from one designated women s health provider (DWHP) at one site, including community based outpatient clinics (CBOCs) Care for acute and chronic illness Gender-specific primary care Preventive services Mental Health services Coordination of care Measured with women s health primary care evaluation tools and evaluated by site visits VETERANS HEALTH ADMINISTRATION 12
Reproductive Health Contraception Preconception Care Maternity Care Coordination Newborn care for up to 7 days Infertility treatment Menopause management Gynecological surgery 13
VA Maternity and Newborn Care MATERNITY CARE NEWBORN CARE Part of benefits package for women Veterans since 1996. Section 206 of the Caregivers and Veteran Omnibus Health Service Act enacted May 2010. 14
VA Maternity and Newborn Care Use of VA maternity care has increased by 44 percent in the past 5 years. VA maternity care is outsourced and provided through community care. Effective maternity care coordination is a critical component of maternity care for women Veterans. VA Care Preconception Care Safe Prescribing Co-Morbid Conditions Pregnancy VA Care Obstetrics Care in the Community VA Care Coordination Care in the Community Completion Obstetrics Record Transfer VA Care / Follow-up Postpartum 15
VHA is Promoting Complementary and Integrative Health Services Helping Veterans focus on self-management and health mind-body techniques, meditation Mindfulness Apps yoga, Tai-chi massage art and music experiences 16
Prosthetic Equipment for Women Women-specific prosthetic items include, but are not limited to: Breast Pumps Nursing Bras Wigs for hair loss Long-Acting Reversible Contraception (e.g., Intrauterine Devices) Maternity Support Belts Items Vaginal Dilators Women s eyeglasses, shoes, etc 17
Continuum Of Mental Health Care Women are increasingly using VA health and mental health services In Fiscal Year (FY) 2017, 44 percent of women Veterans who used VA accessed mental health services VA offers a full continuum of mental health services for women Veterans General outpatient Specialty services Evidence-based therapies Inpatient and residential treatment options (mixed-gender and women-only) 18
Mental Health Issues Among Women Veterans Women Veterans are more likely than male Veterans to be diagnosed with a mental health condition by VA provider In fiscal year 2017: 40 percent of female VHA users had confirmed mental health diagnosis 25 percent of male VHA users had confirmed mental health diagnosis in FY17 As compared to male Veterans, women Veterans have: Higher rates of depression and anxiety Lower rates of substance use Higher rates of mental health and medical comorbidities Clinical complexity among women Veterans with mental health concerns is an area of special focus 19
Innovative Clinical Training Initiatives Multidisciplinary Eating Disorders Treatment Team Training 8-week, 24-hour training delivered via video conferencing 21 teams currently in place Skills Training in Affective and Interpersonal Regulation (STAIR) Cognitive-behavioral trauma treatment that teaches skills for managing strong emotions and building healthy relationships Live web-based trainings in Advanced STAIR and Parenting STAIR Women s Mental Health Mini-Residency 3-day, face-to-face training in gender-tailored treatment approaches, including psychotherapies and psychiatric medications Participants create Action Plans to advance women s mental health care locally and represent their facilities as Women s Mental Health Champions 20
Military Sexual Trauma (MST) MST is the term used by VA to refer to experiences of sexual assault or repeated, threatening sexual harassment that occurred during a Veteran s military service Unfortunately, military sexual trauma (MST) is a part of some women s military experience and can have a significant impact on their mental and physical health VA has implemented a universal screening program in which all Veterans seen for health care are asked about experiences of MST Data from this program reveal that when screened by a VA health care provider, about 1 in 4 women and 1 in 100 men report experiencing MST 21
VA Has Specialized Services To Help All VA health care facilities provide free treatment for any mental and physical health conditions related to a Veteran s experiences of MST Outpatient, inpatient, residential, and pharamaceutical treatment Eligibility for this free care is expansive and some Veterans may be able to receive MST-related care even if they are not able to receive other VA care No length of service requirements No service connection required No documentation of the MST required To access care, Veterans can contact the facility MST Coordinator to learn about services available or ask their existing VA healthcare provider for a referral More information is also available at www.mentalhealth.va.gov/msthome.asp 22
Telehealth and Connected Health Telehealth services Tele-gynecology Tele-mental health Tele-wellness Tele-pharmacy My HealtheVet: https://www.myhealth.va.gov Pharmacy refills, lab results Secure messaging to VA provider New app for appointments rolling out now Many health apps on VA App store: PTSD Coach, MOVE, and Weight loss 23
As of August 31, 2018, the WVCC received 79,692 calls and made 1,213,639 calls with 632,000 of these calls being successful (spoke with Veteran or left a voice message). Implemented chat feature in May 2016 to increase access for women Veterans, responded to 1,689 chats. Women Veterans Call Center 24
Culture Change in VA 25
Air Force (AF) and Veterans Affairs Women s Initiative Transition Assistance for Service Members Department of Defense(DoD)/VA Health Executive Committee identified transition between DoD and VA as the #1 barrier to care for female Veterans Myriad of challenges in relation to suicide Difficult to navigate VA during crisis Get those who need it into mental health support quickly AF/VA partnered to pilot a program and address health care gaps for female Veterans Pilot 1 day health care presentation w/tour of VA facility Registration w/ VHA and VBA Hot hand off between DoD and VA before separation Track females 2 years post service to determine effects of health care presentation, does it address original problem set 26
QUESTIONS?? Contact: Sally Haskell Sally.Haskell@VA.gov 27