We recently conducted a literature review on the health status of women veterans for one of our healthcare clients. Our findings-including summaries and important quotes from the articles we read-are featured here. Our client will use these literature review findings to contextualize a research study they recently conducted on the healthcare systems that support women veterans. We are now working with our client team to compose a journal article that situates their research within the broader conversations happening within this field, as evident in the literature review notes you’ll discover below.
我们强烈认为，公布的研究旨在广泛和公开分享，激发谈话和公共知识产权的增长。探索下面的文献审查说明，了解关于妇女退伍军人医疗保健的最新研究。如果您想了解更多关于VETERAN服务的信息，您可以学习乐动体育娱乐更多在这里。
文献综述结果
Women Veterans are among the fastest-growing segment of new health care users, with as many as 44 percent OEF/OIF Veterans electing to use VHA health care. Today, there are approximately总体而言，2300万退伍军人，其中220万（10％）是女性。根据退伍军人人口预测模型，而预计退伍军人总数将减少2040年，预计妇女退伍军人的百分比将在同一时间框架期间增加到18％。
妇女在历史上被称为“隐形退伍军人”，因为直到最近他们的服务捐款被军事和平民社区都得到了认可(特别报告;Women Veterans Issues）。因此，VA关心内外的提供商继续面对“在历史上专注于治疗男性的系统中组织和提供性别特定和性别敏感服务的挑战”（Yano，Hayes，Wright等，2010）。乐动体育娱乐随着妇女的日益增长的人口，重点是妇女的医疗保健在VHA中越来越重要。
以前的研究承认，女性VA患者面临的独特和复杂的身体，心理和心理社会挑战，与其男性退伍军人和女性民用同行相比，包括与创伤后应激障碍和军事性创伤（MST）相关的斗争（yano etAl。，2006;莱德，2015; MacGregor等人2011; Zinzow等，2007; Yano，Hayes，Wright等人。2010）。女性VA患者的一般人口患有较差的健康状况，甚至与面临严重的慢性病医疗条件的平民妇女相比，引用身体疼痛和情绪和社会功能下降甚至减少了情绪和社会功能（Frayne等，2006; Lehavot等人。，2012）。
当妇女退伍军人报告了与认识其病史的医疗保健提供者一致的关系，强调预防性护理，鼓励行为变化，以满足其健康目标，并了解军事文化。
文献综述来源，摘要和重要报价
- 概括：使用医疗服务提供者和系统（CAHPS）患者中心医疗房（PCMH）调查，基于患者（SHEP）的VA型医疗经验的次级数据的研究研究报告。“邮寄给女子退伍军人的28,994次调查，由初级保健提供者和8,151名妇女回应调查（响应率，32％）。SHEP-CAHPSPCMH调查评估了3,147个提供商（40％; N¼1,267是DWHPS）。在一个多变量的模型中，被指定的女性健康供应商（DWHPS）（相对风险）（1.02; 95％CI，1.01-1.04）的患者报告了与非DWHPS观察的患者进行了更高的整体经验。“
- “The main finding is that women veterans’ experiences with outpatient health care are slightly better for DWHPs compare with non-DWHPs.”
- “除了DWHP状态,我们发现供应商class, for example, NPs versus MDs, to be a factor associated with veterans’ better overall experience with outpatient care. Previous studies have examined differences in patient experiences with care by provider type (NP, PA, and MD) in predominantly male populations. Budzi, Lurie, Singh, and Hooker (2010) found that veteran patients were more satisfied with care by NPs compared with PAs and MDs, and these authors highlighted that NPs focus on health promotion, health education, attentiveness, and counseling. Another non-VA study found older patients (>65 years) were more satisfied with NPs (Cipher, Hooker, & Sekscenski, 2006). Although more research is needed to adjust for time spent with the patient and the complexity of the patients cared for by these providers, this may represent an important finding for VA, the largest single provider of health care in the United States in its mission to care for women veterans. To address the potential scarcity of primary care providers in the future, the VA may need to consider hiring more NPs.”
- “在我们的研究中，越来越多的女性退伍军人的年龄是与门诊护理更好的经验相关的重要因素。许多老年女性退伍军人都有VA Care（沉，Hendricks，Zhang，＆Kazis，2003）的替代方案，并且可能继续使用VA服务，因为他们对他们收到的护理感到满意。乐动体育娱乐使用护理的新女性退伍军人的一半以上45岁以上的57％以09财年增长至64％（Friedman等，2011）。Wright和Co-Workers（2012）建议，21世纪的VA需要对两位家庭人的年轻退伍军人变得更加敏感。“
- “与男性相比，现役军方的妇女有更高的种族和少数群体比例（Patten＆Parker，2011），我们发现与优秀的优质经验相关的非白种族在这个更年轻的退伍军人亚组中很重要比普通的男性退伍军人更常见。这一发现应促进进一步调查，因为它增加了与种族/民族差异存在或缺乏相关的因素的文献（Saha，Freeman，Toure，Tippens和Theeway，2007; Quinones等，2011）。“
- “In our study, 60% of women veterans received care from DWHPs.”
- “Compared with non-DWHPs, DWHPs were more likely to be younger, female, less likely to be MDs, and more likely to be NPs.”
- “初步研究初级保健的经验的经验专注于VA现场差异而不是个人提供者特征。2010年，VA建立的政策要求通过指定的妇女的卫生供应商（DWHPS）提供综合妇女的医疗保健。对DHAP和女子退伍军人的经验提供了从这些提供商的医疗经验的保健质量众所周知。“
- “女性仍然是退伍军人事务部（VA）的少数群体，目前只占VA用户的6％（Frayne等，2012）。然而，过去十年（Frayne等人，2012年）的女性退伍军人的数量翻了一番。“
- 概括: Discusses qualitative interviews with22 WH-PCP在一个MediheStn Medical Center中，并确定六个主题：“1）时间限制，2）工作人员支持的重要性，3）需要足够的空间和设备/用品的必要性，4）创伤患者的不适感，5）缺乏教育/培训，以及6）乐动体育266调度/物流挑战。“结论是，由于他们的多级和多造影性质，这些主题产生的障碍可能需要“特殊政策和实践”。
- “Because VA health care delivery has historically focused on male veterans’ health care needs, what remains unclear are the barriers and facilitators WH-PCPs encounter in their roles in light of the unique and potentially challenging clinical issues that women veteran patients might present. Furthermore, in the comprehensive care model, WH-PCPs face additional requirements in terms of procedures, staffing, and time (e.g., safety requirement for a chaperone during gender-specific examinations, 1-hour instead of 30-minute visits for women veterans who also need Pap or pelvic examinations to be conducted).”
- “There were a few WH-PCPs who even avoided or delayed giving or addressing gender-specific care or issues with their women veteran patients owing to these assumptions regarding MST (e.g., patient preferences for provider gender, readiness).”
- “WH-PCPs seemed to be especially concerned about handling women veterans’ multiple comorbidities under existing time constraints, with most of the participants indicating that 30-minute visits was insufficient, especially if gender-specific care was also needed.”
- “Enhancements in VA leadership communication and administrative support to WHPCPs and staff may also be necessary to effectively overcome some of these barriers, particularly those related to awareness of longer appointment times, problems with scheduling and/or resources, and support for Pap testing.”
- “The adequacy of VA space for delivering appropriate care to women veterans (while also sufficiently attending to their privacy needs) has been a problem in the past (S. Government Accounting Office, 1999). Increased attention to this dilemma has led to the development and greater diffusion of WH clinic models (Yano, Goldzweig, Canelo, &Washington, 2006), but little has been reported about changes in space and privacy for women veterans. The continued growth in numbers of women veterans patients seeking care in VA facilities will likely promote decision makers to invest in space and, in particular, to ensure that a sufficient number of rooms are available for WH-PCPsto conduct pelvic examinations and other gender-specific procedures.”
- 概括：讨论面试研究，旨在了解改善VA急诊部门提供优质妇科服务的促进者和/或障碍。乐动体育娱乐该研究包括与14名ED董事/提供商，13名ED护士经理，13名VA设施的董事管理人员和13名女子资深计划经理组成。结果指出了影响VA EDS构建能力和改善妇科护理的能力的几个重要因素，包括领导，员工，空间，需求，资金，政策和社区。
- “领导力，员工，空间，需求，资金，政策和社区被指出，影响VA EDS建设能力和改善女性退伍军人紧急妇科护理的重要因素。这些因素被交织在一起并交叉多个组织层面，使每个ED的能力不仅是其自身因素的反映，也是其当地医疗中心和非VA社区背景以及VA区域和国家趋势和政策的反映。
- “旨在建立VA的政策和质量改善举措，旨在为妇女的紧急妇科服务提供多项组织层面的多重态度，并旨在实现多项组织层面。乐动体育娱乐政策需要灵活地占EDS及其医疗中心和社区背景的广泛变化。“
- “在过去十年中，使用退伍军人管理局（VA）服务的女性退伍军人数量呈指数级增长，2013年使用VA服务的近40万名女性，但尽管这一增长，女性仍然是VA的一小部分（7％）乐动体育娱乐患者人口，因此满足其性别特定需求是一个组织挑战。“
- “Women Veterans may have different emergency care needs, and may require different resources and processes of care than male Veterans. For example, approximately 40% of women using VA services are in their childbearing years and may present with gynecologic emergencies”
- 概括：关于一个专注于女性健康的VHA初级护理提供者的虚拟咨询计划的混合方法研究报告。所有受访者都报告说，该计划对于增加WH知识有用，89％的会议后受访者同意会议中的信息会影响其患者护理。作者得出的结论是,协商程序holds promise to improve PCP knowledge of WH and therefore influence patient care.
- “女性退伍军人是退伍军人健康管理局（VA）患者之间迅速增长的少数群体。虽然道德和司法有权获得相当于其男性同行的护理，但实现这一目标是一个组织挑战。“
- “VA is committed to the goal of delivering equitable, high-quality, and comprehensive health care to women Veterans.14 Concordantly, VA has invested in numerous initiatives to improve sex-specific and sex-related care provided in primary care settings.”
- 概括：使用具有11名临床医生和社会科学家的专家面板方法，以确定医疗保健的各个方面应根据妇女退伍军人的需求量来确保性别敏感护理。小组同意的14个建议“这主要包括重要性(1) the design/delivery of services sensitive to trauma histories, (2) adapting to women’s preferences and information needs, and (3) sex awareness and cultural transformation in every facet of VA operations.”
- “The panel ratings suggest that meeting women Veterans’ needs will require tailoring the orientation, education, and training of the VA workforce to meet clinical care needs (eg, gender incorporated into guideline implementation) and to transform the organization’s culture to be more gender sensitive.”
- “Improving the gender sensitivity of the VA workforce, given generations caring for men, could prove challenging. Certainly, universal access to same-sex employees is unlikely, as federal hiring practices preclude use of sex as a criterion. The VA has instead focused on proficiency, which is arguably more important as women are not automatically embued with gender sensitivity by virtue of their sex. Establishing women’s health proficiency standards (ie, training, minimum patient volumes) has resulted in placement of designated providers in the vast majority of VA facilities.43”
- 概括：描述了一项关于“识别VHA患者”和“提供商的观点的一项研究，了解如何在VHA中促进IPV检测和关注。”研究团队采访了25名女子退伍军人和15名VHA医疗保健提供者，发现驳回IPV到提供商，充分的回应和随访护理。
- “Extending prior work on barriers and facilitators to IPV screening (Iverson et al., 2013b; Iverson et al., 2014), we focus here on barriers to – and recommendations for – facilitating patient disclosure of IPV and health care provider and system response to disclosures, within the VHA.”
- 数据分析：“我们利用归纳方法来数据分析，开发编码方案并通过密切阅读数据（Thomas，2006）来识别主导主题。研究团队的三名成员，包括第一作者，每次阅读成绩单，并注意到与IPV披露和响应相关的共同主题。研究团队在一起基于所确定的主题开发了初步编码结构。然后，研究团队的两个成员使用NVivo软件编码了每个成绩单，所述代码添加并酌情补充到数据并由研究团队达成一致。然后，研究团队审查了编码报告，以协商一致了关于数据中所确定的主题。该团队从转录的转录程序中选择了示例，反映了所描述的每个主题。“
- “This study provides insights from both patients and providers that can help to inform the implementation of IPV screening and response in VHA and may also be relevant to IPV programs in other health care settings. Findings were both consistent with existing literature on IPV detection and response outside of the VHA setting and also revealed VHA-specific considerations that can inhibit disclosure as well as offer new opportunities for intervention. Results replicate and extend previous work finding that IPV disclosure is rare in the absence of direct inquiry (Gerbert et al., 1999); that lack of time, information, and resources inhibit provider screening (Gerber et al., 2005; Iverson et al., 2013b; Waalen, Goodwin, Spitz, Petersen, & Saltzman, 2000), and that lack of comfort with the provider or not feeling ready to talk about the violence inhibits patient disclosure of IPV (e.g., Iverson et al., 2014). Further extending the literature, results highlight concerns about potential negative consequences of IPV disclosure that were specific to VA system factors and unique to the VA’s integrated health care system. Additionally, VHA patients and providers noted a desire for both in-house resources to address IPV-related needs as well as a more streamlined process for connecting patients with community-based services.”
- 概括: Reports on a new national program piloted by the VHA that seeks to increase clincians’ knowledge of and comfort with treating transgender Veterans. After participating in the 7-month program, evaluation respondents reported that their confidence to treat transgender Veterans had increased significantly.
Lehavot K，Simpson TL。将女同性恋和双性恋妇女纳入女性退伍军人的健康优先事项。J Gen Intern Med. 2013 Jul; 28 (Suppl 2): S609-14.
- 概括：引证对女同性恋和双性恋女性退伍军人缺乏研究，这篇文章调查了关于LB女性退伍军人经验的可用数据。这些包括遭受歧视和受害的可能性，以及访问医疗保健方面的许多独特问题，包括对退伍军人健康管理（VHA）提供者的不敏感护理和难以披露性取向的担忧。“Lehavot和Simpson得出结论，培训，外展和对女同性恋和双性乐动体育266恋妇女退伍军人的研究对公平保健交付至关重要。
Levander, XA, Overland MK.Care of women veterans.Med Clin North Am. 2015 May; 99 (3): 651-62.
- 概括: Discusses shift in US Veteran population to include more women and the resulting impact on women’s overall health.通过美国军事文化的提供者和“女士退伍军人的独特医学，精神病和心理社会需求”，争论更好的理解。
- This article seems geared toward civilian providers. It argues for a better understanding by providers of the US military culture and the “unique medical, psychiatric, and psychosocial needs of women veterans.” This may or may not be applicable in the VA setting. Not ALL providers served in the military and may in fact need some additional training regarding the unique service of women Veterans.
- “为了开放关于军事服务对患者健康影响的潜在影响的对话，提供者必须要求所有患者询问他们是否在军队中服务，特别是一些退伍军人可能不会初始志愿这些信息。”
- “With the creation of the Women Veterans Task Force of the Department of Veterans Affairs in 2012, the VA has recognized that women veterans represent a unique patient population with specific medical, psychiatric and psychosocial care needs, and that the VA system will need to change in order to optimally deliver health care to this evolving population.”
- 关于护理协调：“所有医疗保健提供者都应该认识到妇女退伍军人的复杂需求，因为这个人口往往在VA系统之外收到大部分护理。据估计，24％的女子退伍军人使用VA卫生保健系统，只有5.1％独家使用VA。“
- 概括: Uses qualitative research to explore the structure and development of the VA’s separate/designated mental health services for female Veterans. Interviews with VA mental health administrators and providers demonstrateda wide variety of arrangements for women’s mental health service delivery and suggested the presence of “champions” at most facilities, barriers to viability, and concern about stigmatization surrounding separate services for female Veterans.
- “许多女性退伍军人具有重要的心理健康状况（例如，抑郁症），往往以不成比例的速度比其男性对应物更高;在军事服务期间性创伤等经验也不成比例地影响女性退伍军人，需要知情的待遇方案。“
- “与以前的队列相比，这些冲突的妇女[OEF / OIF]正在向前所未决的水平注册VA保健。”
- “目前，不存在单一推荐的模型，用于在VA中提供女性心理保健。初步证据表明，VA中妇女的心理医疗保健安排是妇女初级保健服务安排的类似模式。“
- 概括：关于评估vHA指定WH提供商的早期实施的报告，该公司在2010年成立的国家政策，优先将妇女患者分配给预计“保持全面的WH关心的熟练程度”的提供者。评估发现，19％的被指定的WH提供者看到的患者是女性，而其他PCP的5％相比，建立的女性退伍军人比新患者更容易看到指定WH提供者。
- “特别是，VHA政策指出，如果网站上没有足够的女性为指定WH提供者达到10％的批量标准，则其他手段可用于维护熟练程度。未来的评估可以更详细地检查这一点。例如，在社区诊所，指定WH供应商倾向于看到较少的女性退伍军人，供应商可能会从其他机会获利，以持续熟练，如参加VHA WH Mini-Residency，继续医学教育培训或辐射安排。“乐动体育266
- “Although data on how VHA’s proficiency standards and training initiatives translate into quality of care are lacking, recent work suggests that women are more satisfied with Designated WH Providers19 and receive higher rates of screening for breast and cervical cancer from them than from other providers.”20
- “大量女性退伍军人（48％）看到了指定WH供应商和其他PCP。这可能会使女性面临护理碎片的风险，特别是如果通过收到非VHA护理（通过VHA的费用基础制度18或由私人私人提供）而另外复杂。“
- 概括：本研究采用了混合方法研究设计来检查女性退伍军人患者在VA医疗中心的护理体验。该研究发现一般的满意度率很高，其中人口统计数据有所不同。“定性访谈揭示了对以下主题的关注的看法：1）照顾延迟的障碍所需的医疗保健，而创新的护理模型促进了妇女价值沟通和关心的妇女价值沟通和协调，以及3）VA Care的个性化背景，包括gender sensitive care shapes women’s perceptions.”
- Findings highlight convergence of women’s preferences with PACT priorities of timely access to care, provider communication, and coordination of care, and suggest areas for improvement. Outreach is needed to address gaps in knowledge and negative perceptions.
- “Organizational features of care, including availability of women’s clinics or primary care models tailored to women’s needs, female providers, and gender-specific services (Bean-Mayberry et al., 2003, 2006a, 2006b; Washington, Bean-Mayberry, Mitchell, Riopelle, & Yano, 2011a) are associated with greater satisfaction among women VA users.”
- “Analysis of the interviews revealed women’s experiences with care to be centered on the following themes: 1) barriers to care delay needed medical care, while innovative care models facilitate access, 2) women value communication and coordination of care, and 3) personalized context of VA care shapes women’s perceptions of quality.”
- “患者与提供者之间的沟通和协调和关注的关注。这些价值观在他们对VA护理的积极和负面经历的描述中显而易见的。“
- “In addition to continuity of care across providers and services, women valued continuity of care over time within their relationship with their providers. Women talked about wanting a doctor who knew them and their medical history.”
- “妇女关于评估提供商通信的人际关系，包括提供者的方式敏感，花时间与他们建立关系并分享，因为参与者6将其置于”个人连接“。
- Personal Connection:
- “患者与提供者之间的沟通和协调和关注的关注。这些价值在他们对VA护理的积极和负面经验的描述中显而易见。参与者9.描述了欣赏她的医生是如何“全部合作的。”同样地，参与者10.liked the team-based approach where all members of her care team communicated with one another and knew her medical history:
- “Women talked about wanting a doctor who knew them and their medical history.Participant 11requested a doctor who knew her after having repeatedly to describe her medical history to new residents. Women valued their doctors’ emphasis on preventive care and encouragement of behavioral change to meet their health goals, appreciating that their doctors, asParticipant 10措辞，“留在我身上”，比如吸烟或减肥等目标。“
- “妇女关于评估提供商通信的人际关系，包括提供者的方式，作为敏感，花时间与他们建立关系并分享参与者6.put it, a “personal connection.”
- 男性主导的环境：
- 妇女注意到感觉“超过男人”（participant 19）并且好像他们的需要没有优先考虑。他们描述了VA为妇女提供额外的性别敏感服务，包括妇女的支持小组和方案。乐动体育娱乐与会者强调了认识到他们的身份和经验作为退伍军人和妇女的重要性，他们应该可以获得与男性退伍军人相同的护理水平，并且还需要尊重他们的性别特定问题。Participant 13commented: I think they should definitely provide programs for women. They need to remember that we’re veterans as well. Don’t just exclude me from certain things just because I’m a female. This statement reflects participants’ call both for inclusion as part of the larger veteran community and for attention to their unique needs as members of a minority veteran community.”
- “在主要的男性VA环境中，参与者反映了具有指定女性健康诊所的价值，不仅是女性提供商可用的性别敏感服务的来源，而且作为分配给女性的单独物理空间。乐动体育娱乐这在第一次遇到诊所的妇女的描述中是明显的，作为对与VA Care的对或经验的前瞻性看法的欢迎造影。参与者5., who had recounted initial discomfort with the VA’s predominantly male environment, subsequently learned of and sought care through the women’s health clinic and said of her experience there, “It’s needed, and a shelter.”Participant 12诊所说：“他们确保他们雇用女医生，让它更舒服，他们很棒。”若干参与者指出，与缺乏性别敏感的服务相关的负面经验，包括接受住院服务的妇女缺乏隐私和独立空间，以及妇女的可用性为心理健康问题。乐动体育娱乐
- 关于VA服务的知识差距：乐动体育娱乐
- 一些参与者，所有这些参与者在采访时接受了VA服务，报告了他们在基于误解或不准确的资格要求的信息，以乐动体育娱乐及对VA护理的初步消极看法的初步看法。虽然这是较年轻的参与者的突出者，从早期的兵役时代，一些更年轻/最近（OEF / OEF）时代退伍军人报告延迟初步获得VA护理和负面看作作为这种进入的障碍。Participant 14，越南后的越南时代曾担任过谁：我只是以为[Va Care]将是我必须退休的事情或积极努力利用。我不知道。Participant 15, who had likewise served in the post Vietnam era and was married to a veteran, had been told years earlier when she accompanied her husband to a VA Medical Center that she was not a veteran: The young lady that was in there, she said, “Oh no, you ain’t no veteran.” And it was like somebody just crushed me. And I’m telling myself, now I know I was there, I know I was there. But I can’t even describe the hurt that I was feeling. I don’t take rejection too well, and I just thought okay I’m not a veteran. And I held onto that.
- 概括: “Assessed women veterans’ ratings of their VA health care quality, gender-related satisfaction, gender appropriateness, and VA provider skills in treating women, in relation to primary care model at VA sites nationwide.” Found that “Adopter sites received higher adjusted ratings of gender-related satisfaction and perceptions of VA provider skills than non-adopter and small sites. Adopter sites also received higher adjusted ratings of gender appropriateness than small sites. Adjusted ratings of quality of care did not differ by type of site.”
- 对于女性量身定制的初级保健模型的VA站点在大多数护理方面被评为更高。促进在其他网站上建立这些最佳护理模型是改善女性退伍军人与VA护理经历的一种策略。研究识别与质量相关的其他关心特征可以通知正在进行的VA质量转变工作。
- “VA站点为具有指定供应商，团队或全面的女性健康中心的妇女量身定制的初级保健交付安排，在大多数护理维度上有更高的妇女退伍军人的评级。随着VA达成剥夺妇女退伍军人，使他们的医疗保健经验有益和令人满意的是迈向加强其VA护理的患者中心的重要一步。促进在其他网站上建立推荐的护理模型是改善女性退伍军人与VA护理经历的一种策略。VA之外的医疗保健设置旨在提高女性与护理的满意应应考虑女性初级保健安排的类似改变。“
Yano Em，Goldzweig C，Canelo I，华盛顿DL。妇女保健交付中的创新扩散：退伍军人事务部采用妇女健康诊所。妇女的健康问题。2006年10月 - 八月;16（5）：226-35。
- 概括: Reports on 2001 survey of “the senior women’s health clinician at each VA medical center serving > or =400 women veterans (83% response rate) regarding their internal organizational characteristics in relation to factors associated with organizational innovation (centralization, complexity, formalization, interconnectedness, organizational slack, size).” Study found that “WHCs were less likely to have same-gender providers (p < .05), women's health training programs (p < .01), separate women's mental health clinics (p < .001), separate space (p < .05), or adequate privacy (p < .05); however, they were less likely to have experienced educational program closures (p < .001) and staffing losses (p < .05) compared to CWHCs."
- More research is needed to examine the quality of care associated with these models and to establish the business case for managers faced with small female patient caseloads.
- “他们不增长最快的领域之一w users of the US Department of Veterans Affairs (VA) health care system, projected to be 10% of the total population of veteran users by 2010 (US Department of Veterans Affairs, 2002). However, in contrast to community health care settings where women are likely to outnumber men, women veterans represent only between 5-7% of the total veteran population using VA health care services.”
- “In 1982, the US GAO released a report highly critical of VA’s lack of general and gender-specific services and inadequate privacy for women (US GAO, 1982). Another 10 years passed before the GAO reviewed the VA’s progress again, and although some gains were evident, concerns about the availability and privacy of services for women remained.”
- “他们的数值少数群体在试图创造交付系统方面创造了后勤挑战，以确保他们公平地获得高质量，全面的卫生服务，特别是性别特定的护理退伍军人，而不是女性非凡人的同行和健康的身体和心理健康负担更高乐动体育娱乐与男性退伍军人的负担相当或差。“
- “妇女的卫生领导者并不是融入当地的临床或行政委员会。妇女的健康协调员更有可能与WWHC（综合女性健康中心）（妇女健康诊所）的其他提供者提供重要信息的重要信息p_ .05).”
- “As women continue to enter the system, VA policymakers may want to foster peer networks, encourage local monitoring of women veterans’ needs, and report gender-specific performance to support further innovation.”
- “The growth of WHCs in VA generally bodes well for improving the quality of care available to women veterans. Women veterans’ satisfaction with care is higher in women’s clinics than in traditional primary care clinics (Bean-Mayberry et al., 2003). Their use of VA versus non-VA care has also been found to be directly influenced by the scope of clinical services, especially availability of routine gynecologic care within primary care settings which reduces fragmentation of women’s care.”
- “尽管有这些进展，但妇女退伍军人使用VA护理的障碍仍然存在。最近的研究表明，女性退伍军人的知识和对VA妇女医疗服务的认识（华盛顿等，2006年）的知识和意识，以及对易于使用VA的令人担忧以及所需服务的可用性的担忧。“乐动体育娱乐
- “VA采用妇女医疗保健的新护理模型为满足了符合复杂的医疗保健需求的竞争迅速增长的符合条件的用户（华盛顿等，2006）的挑战，为满足了迅速增长的符合条件的用户的挑战。”
- “VA的采用妇女的医疗保健计划可能会继续需要集中和分散的扩散技术的组合，以便长期产生福利。建立一些核心妇女的健康专业知识似乎是关键，尽管在较少的组织松弛的较小网站中完成这一点可能需要集中支持和监督。扩散理论还表明，管理人员可以通过进一步支持这些临床计划的相互关联，促进新想法的合作和沟通来利用他们的资源，以应对提供妇女医疗保健的挑战。“
- 概括：解决适用于符合妇女退伍军人的需求的契约。本文介绍了VA初级护理交付如何发展，以便为女性退伍军人提供服务，评论VA对女性的性别敏感综合级别保健的政策，并讨论了契约通过女退伍军人的需求挑战，结论是在提出建议的结论。
- “虽然军事参与的历史差异意味着在VA医疗保健环境中很少看到女士退伍军人，但现在代表了最快的新VA用户节目。它们还具有复杂的医疗保健需求，为VA必须提供的服务频谱添加了特定的特定服务和其他需要。乐动体育娱乐这些趋势正在改变VA景观，引入如何培训VA Care的挑战，如何培训VA提供商，以及VA如何考虑实施新举措，例如PACT。“
- “与通常pract平衡性别混合ices outside the VA, women veterans represent a numerical minority, at about 7 % of VA users. Their numbers have created proficiency challenges among VA providers and logistical and fiscal challenges to delivering comprehensive PC in gender-sensitive environments that take account of women’s military roles/experiences and complex healthcare needs.3–5 Women VA users have higher mental health burdens than their male counterparts, including high rates of exposure to military sexual trauma, which require trauma sensitive approaches to care and special attention to the safety and security of clinic environments.6–8 Their quality of care has also lagged behind that of men,9 and they typically have to seek multiple visits within and outside the VA to achieve the level of care men achieve through a single on-site visit.10–11”
- “There is growing awareness of the complexity and constraints of effectively and efficiently delivering PC to women veterans in a healthcare system where they represent a characteristically low volume of patients.”
- “必须仔细注意妇女如何访问和使用PC，他们的医疗保健需求的混合以及PC团队必须获得和维持的挑战的差异。”
- 概括：作者“描述了女子退伍军人的健康和保健使用，注意到VA护理是如何满足他们的需求，报告质量的性别差异，突出了女性退伍军人质量改进的国家计划，并讨论了VA妇女的健康研究。[他们]然后讨论越来越多的妇女退伍军人在VA研究中代表的挑战和潜在解决方案，包括实施研究的步骤。“
- “在女子退伍军人中，VA用户比VA非用户更有可能获得低收入，没有医疗保险，卫生地位和社会支持，以及军事服务关联的残疾.6他们的心理健康和慢性病负担与雄性VA相当用户;顶部诊断包括创伤后应激障碍（PTSD），高血压，抑郁，高脂血症和慢性腰痛。8,9“
- “随着女性退伍军人在越来越多的数量进入VA卫生保健系统，VA管理人员和提供商在历史上专注于治疗男人的系统中组织和提供性别特定和性别敏感服务的挑战。”乐动体育娱乐
- “However, some providers may be unwilling to participate in research because of high caseloads. While clinicians working with men may face similar time pressures, our anecdotal experience suggests that pressures are greater for clinicians who focus their practice on women, perhaps due to more limited clinical backup and administrative support in women’s programs.”