Impact of Gender Identity Field in the Veterans Health Administration Electronic Health Record, 2016‒2023

American Journal of Public Health, Год журнала: 2025, Номер unknown, С. e1 - e11

Опубликована: Янв. 16, 2025

Objectives. To distinguish differences in physical and mental health between transgender gender-diverse (TGD) veterans identified via diagnostic codes, self-identification, their combination. Methods. We used sociodemographic characteristics diagnoses for TGD receiving care Veterans Health Administration (VHA). Results. Among the cohort of 12 745 veterans, 69.3% were solely using self-reported gender identity data, 23.4% only TGD-related 7.2% had both codes data medical record. younger more racially ethnically diverse compared with those codes. Across nearly all independently examined conditions, at lower risk Conclusions. Inferences drawn from studies veteran may be significantly impacted by choice methodology defining cohort. New analyses as opposed to are critical understand this population within VHA. ( Am J Public Health. Published online ahead print January 16, 2025:e1–e11. https://doi.org/10.2105/AJPH.2024.307920 )

Язык: Английский

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A pre/post quasi-experimental study of provider stigma and Veteran experiences surrounding a narrative “IDEAS” intervention to promote positive clinical encounters

Research Square (Research Square), Год журнала: 2025, Номер unknown

Опубликована: Март 10, 2025

Background: Transgender and gender diverse (TGD) Veterans face significant health disparities, often exacerbated by provider stigma. The US Department of Affairs (VA) prioritizes research to improve care for TGD Veterans. This study evaluates the feasibility acceptability IDEAS - a film-based intervention designed reduce stigma clinical encounters Methods: A pre/post quasi-experimental design was used assess impact on Veteran experiences. involved primary mental providers from Midwestern VA Medical Center who had appointments within six months before after intervention. Providers completed Acceptability Intervention Measure (AIM) Feasibility (FIM) post-IDEAS, Acceptance Action Questionnaire – Stigma (AAQ-S) pre post-intervention. Consumer Assessment Healthcare Systems Cultural Competence Item Set (CAHPS-CC) an author-created survey. Results: found be both acceptable feasible, with average AIM FIM scores above 4. Provider stigma, as measured AAQ-S, decreased significantly post-intervention (p<0.01). reported improved perceptions cultural competence affirming post-intervention, notable improvements in communication, trust, respect. Conclusions: shows promise reducing enhancing healthcare experiences Further is needed explore long-term such interventions outcomes refine assessment tools capturing nuanced patient

Язык: Английский

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Intersectional Discrimination Is Associated with Housing Instability among Trans Women Living in the San Francisco Bay Area

International Journal of Environmental Research and Public Health, Год журнала: 2019, Номер 16(22), С. 4521 - 4521

Опубликована: Ноя. 15, 2019

Trans women face numerous structural barriers to health due discrimination. Housing instability is an important determinant of poor outcomes among trans women. The purpose this study was determine if experiences intersectional anti-trans and racial discrimination are associated with housing in the San Francisco Bay Area. A secondary analysis baseline data from *National (n = 629) at Department Public Health (2016-2018) conducted. Multivariable logistic regression used analyze association between as ordered categorical variable (zero, one two, or three more experiences) status adjusting for age, years lived Area, gender identity. We found that odds increased by 1.25 every unit increase (1-2, 3+) reported (both racial) (95% CI 1.01-1.54, p-value < 0.05). Intersectional women, giving some insight policies programs needed identify address racism stigma towards Efforts may positively impact stability, potential ancillary effects on increasing wellness who multiple disparities.

Язык: Английский

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Improving musculoskeletal injury surveillance methods in Special Operation Forces: A Delphi consensus study

PLOS Global Public Health, Год журнала: 2022, Номер 2(1), С. e0000096 - e0000096

Опубликована: Янв. 20, 2022

Musculoskeletal injury mitigation is a priority in military organisations to protect personnel health and sustain capable workforce. Despite efforts prevent injury, inconsistencies exist the evidence used support these activities. There are many known limitations surveillance data reported previous Special Operation Forces (SOF) research. Such studies often lack accurate, reliable, complete inform evaluate prevention This research aimed achieve expert consensus on methods SOF enhance quality of that could be this population. A Delphi study was conducted with various stakeholders seek agreement improving SOF. Iterative questionnaires using close open-ended questions were collect views about related case definitions identifying essential optional requirements. Consensus predefined as 75% group an item. Sixteen participants completed two rounds required. achieved for 17.9% (n = 7) first-round 77.5% 38) round questions. Several challenges identified, including recording causation, personnel's reporting behaviours influencing accurate collection, system infrastructure limitations. Key need improved collection underpins efforts. The process has resulted preliminary recommendations future surveillance.

Язык: Английский

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Understanding the Context for Incorporating Equity into Quality Improvement Throughout a National Health Care System

Health Equity, Год журнала: 2023, Номер 7(1), С. 312 - 320

Опубликована: Май 1, 2023

Although health care systems aspire to deliver equitable care, practical tools that empower the workforce weave equity throughout quality improvement (QI) processes are lacking. In this article, we report findings from context of use interviews informed development a user-centered tool support equity-focused QI.Semistructured were conducted February April 2019. Participants included 14 medical center administrators, departmental or service line leaders, and clinical staff involved in direct patient three Veterans Affairs (VA) Medical Centers within single region. Interviews covered existing practices for monitoring (i.e., priorities, tasks, workflow, resources) explored how data might fit into current processes. Themes extracted through rapid qualitative analysis used draft initial functional requirements QI.Although potential value examining disparities was clearly recognized, necessary lacking most measures. Interviewees also desired guidance on inequities could be addressed QI. The ways which QI initiatives selected, carried out, supported had important design implications QI.The themes identified work guided national VA Primary Care Equity Dashboard VA. Understanding out across multiple levels organization provided successful foundation upon build thoughtful engagement around settings.

Язык: Английский

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Health Insurance and Mental Health Care Utilization Among Adults Who Identify as Transgender and Gender Diverse

Psychiatric Services, Год журнала: 2019, Номер 71(2), С. 151 - 157

Опубликована: Окт. 29, 2019

Objective: Transgender people are less likely to have health insurance, which has been associated with reduced utilization of care. In the current study, authors sought assess role insurance in mental care among transgender individuals. Methods: A total 4,334 adults who self-identified as or gender diverse (neither male nor female) participated 2017 Trans Lifeline Mental Health Survey, included self-report measures type and lifetime history having seen a therapist psychiatric provider. Logistic regression analyses assessed association status Results: Although only 8% sample were uninsured, these individuals significantly provider their compared those even after adjusted for sociodemographic factors. Conversely, through military Veterans Administration more than twice employer-provided There no significant differences between versus public privately purchased insurance. Conclusions: Rates being uninsured lower earlier assessments identify diverse. However, also appeared be notable structural factor contributing disparities

Язык: Английский

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Exclusion of Medically Necessary Gender-Affirming Surgery for America's Armed Services Veterans

The AMA Journal of Ethic, Год журнала: 2018, Номер 20(4), С. 403 - 413

Опубликована: Апрель 1, 2018

Gender dysphoria, the term used in fifth edition of Diagnostic and Statistical Manual Mental Disorders(DSM) to describe distress at incongruence between one's gender anatomy, affects approximately 0.6 percent population. It is estimated that there are 134,000 Armed Forces veterans United States with dysphoria. Although gender-affirming surgery widely accepted as a medically necessary intervention for appropriately selected patients Veterans Health Administration (VHA) Benefits package VHA Directive 2013-033 specifically prohibit within Affairs (VA) facilities or using VA funding. This policy, which has been legally challenged after being reaffirmed January 2017, denies care veterans, causing harm individual reinforcing discrimination prejudicial treatment minority We argue policy indefensible it violates basic ethical principles beneficence, nonmaleficence, justice.

Язык: Английский

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Rolling out PRIDE in All Who Served: Barriers and Facilitators for Sites Implementing an LGBTQ+ Health Education Group for Military Veterans

Journal of General Internal Medicine, Год журнала: 2023, Номер 38(S3), С. 849 - 856

Опубликована: Июнь 20, 2023

The Veterans Health Administration (VHA) PRIDE in All Who Served health education group (PRIDE) was developed to improve equity and access care for military veterans who are lesbian, gay, bisexual, transgender, queer, and/or other sexual/gender-diverse identities (LGBTQ+). This 10-week program rapidly spread over 30 VHA facilities 4 years. receiving experience improved LGBTQ+ identity-related resilience reductions suicide attempt likelihood. Despite PRIDE's rapid across facilities, information is lacking on implementation determinants. current study's goal clarify determinants of sustainment.A purposive sample staff (N = 19) with delivering or implementing completed teleconference interviews January-April 2021. interview guide informed by the Consolidated Framework Implementation Research. Rapid qualitative matrix analysis methods ensure rigor (e.g., triangulation investigator reflexivity).Key barriers facilitators were heavily related facility inner setting (what happening inside facility), including readiness leadership support LGBTQ+-affirming programming, training) culture systemic anti-LGBTQ+ stigma). Several process enhanced engagement at sites, such as a centrally facilitated learning collaborative formal contracting/training new sites.Although aspects outer larger societal influences mentioned, majority factors impacting success level therefore may be more readily addressable through tailored support. importance indicates that facilitation should ideally address institutional addition logistics. Combining effective interventions attention local needs will required before all areas benefit from equity-focused interventions.

Язык: Английский

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Prostate Specific Antigen and Prostate Cancer in Gender Affirming Hormone Therapy for Transgender or Nonbinary Individuals

International Journal of Radiation Oncology*Biology*Physics, Год журнала: 2024, Номер 121(3), С. 761 - 767

Опубликована: Сен. 30, 2024

Язык: Английский

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Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders

SSM - Population Health, Год журнала: 2022, Номер 19, С. 101153 - 101153

Опубликована: Июнь 29, 2022

Язык: Английский

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