المؤلفون: Kapczynski Jd A; Yale Law School, New Haven, Connecticut.

المصدر: JAMA [JAMA] 2024 Jun 18; Vol. 331 (23), pp. 1995-1996.

نوع المنشور: Editorial; Comment

بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE

مواضيع طبية MeSH: Drug Industry*/legislation & jurisprudence , United States Federal Trade Commission*, United States ; Government Regulation ; United States Food and Drug Administration ; Humans

المؤلفون: Tyagi P; South Florida Veteran Affairs Foundation for Research & Education, Miami, FL, United States., Bouldin ED; Division of Epidemiology, Department of Internal Medicine, University of Utah Eccles School of Medicine, Salt Lake City, UT, United States., Hathaway WA; Providence Veterans Affairs Medical Center, Providence, RI, United States., D'Arcy D; Canandaigua VA Medical Center, Department of Veterans Affairs, Canandaigua, NY, United States., Nasr SZ; VISN 8 Network Office, Department of Veterans Affairs, St. Petersburg, FL, United States., Intrator O; Department of Public Health Sciences, University of Rochester, Rochester, NY, United States.; Geriatrics and Extended Care Data Analysis Center, Canandaigua VA Medical Center, Canandaigua, NY, United States., Dang S; Miami VA GRECC, Miami VA Healthcare System, Miami, FL, United States.

المصدر: JMIR research protocols [JMIR Res Protoc] 2024 Jun 14; Vol. 13, pp. e57341. Date of Electronic Publication: 2024 Jun 14.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101599504 Publication Model: Electronic Cited Medium: Internet ISSN: 1929-0748 (Electronic) Linking ISSN: 19290748 NLM ISO Abbreviation: JMIR Res Protoc Subsets: MEDLINE

مواضيع طبية MeSH: United States Department of Veterans Affairs*/organization & administration, Humans ; United States ; Veterans ; Self Care/methods ; Program Evaluation ; Caregivers

مستخلص: Background: The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers.
Objective: We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs' reach and implementation and identify veterans served by VISN 8's VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8.
Methods: The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site.
Results: We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8.
Conclusions: The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands.
International Registered Report Identifier (irrid): DERR1-10.2196/57341.
(©Pranjal Tyagi, Erin D Bouldin, Wendy A Hathaway, Derek D'Arcy, Samer Zacharia Nasr, Orna Intrator, Stuti Dang. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 14.06.2024.)

المؤلفون: Seadler BD; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA., Melamed J; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA., Sow M; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Rogers AL; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA., Syed A; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Linsky PL; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA., Ubert HA; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Schena S; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA., Durham LA; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Almassi GH; Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Cardiothoracic Surgery, Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.

المصدر: Artificial organs [Artif Organs] 2024 Jun; Vol. 48 (6), pp. 675-682. Date of Electronic Publication: 2024 Feb 06.

نوع المنشور: Journal Article; Case Reports

بيانات الدورية: Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 7802778 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1594 (Electronic) Linking ISSN: 0160564X NLM ISO Abbreviation: Artif Organs Subsets: MEDLINE

مواضيع طبية MeSH: Extracorporeal Membrane Oxygenation*/methods , Shock, Cardiogenic*/therapy , United States Department of Veterans Affairs* , Hospitals, Veterans*, Humans ; United States ; Male ; Middle Aged ; Aged ; Female ; Respiratory Insufficiency/therapy ; Cardiac Surgical Procedures/methods ; Retrospective Studies ; Patient Transfer

مستخلص: Introduction: For the Veterans Health Administration (VHA) to continue to perform complex cardiothoracic surgery, there must be an established pathway for providing urgent/emergent extracorporeal life support (ECLS). Partnership with a nearby tertiary care center with such expertise may be the most resource-efficient way to provide ECLS services to patients in post-cardiotomy cardiogenic shock or respiratory failure. The goal of this project was to assess the efficiency, safety, and outcomes of surgical patients who required transfer for perioperative ECLS from a single stand-alone Veterans Affairs Medical Center (VAMC) to a separate ECLS center.
Methods: Cohort consisted of all cardiothoracic surgery patients who experienced cardiogenic shock or refractory respiratory failure at the local VAMC requiring urgent or emergent institution of ECLS between 2019 and 2022. The primary outcomes are the safety and timeliness of transport.
Results: Mean time from the initial shock call to arrival at the ECLS center was 2.8 h. There were no complications during transfer. Six patients (86%) survived to decannulation.
Conclusion: These results suggest that complex cardiothoracic surgery can be performed within the VHA system and when there is an indication for ECLS, those services can be safely and effectively provided at an affiliated, properly equipped center.
(© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

المؤلفون: Dizon MP; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.; Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA., Kizer KW; Stanford University School of Medicine, Stanford, California, USA., Ong MK; Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.; David Geffen School of Medicine and Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA., Phibbs CS; Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA.; Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA., Vanneman ME; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.; Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA., Wong EP; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA., Zhang Y; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.; Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA., Yoon J; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.; Department of General Internal Medicine, School of Medicine, University of California at San Francisco, San Francisco, California, USA.

المصدر: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2024 Jun; Vol. 40 (3), pp. 446-456. Date of Electronic Publication: 2023 Nov 30.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Blackwell Country of Publication: England NLM ID: 8508122 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1748-0361 (Electronic) Linking ISSN: 0890765X NLM ISO Abbreviation: J Rural Health Subsets: MEDLINE

مواضيع طبية MeSH: Veterans*/statistics & numerical data , Rural Population*/statistics & numerical data , United States Department of Veterans Affairs*/statistics & numerical data , United States Department of Veterans Affairs*/organization & administration , Health Services Accessibility*/statistics & numerical data , Health Services Accessibility*/standards , Urban Population*/statistics & numerical data, Humans ; United States ; Male ; Female ; Middle Aged ; Cross-Sectional Studies ; Aged ; Adult ; Hospitals, Veterans/statistics & numerical data

مستخلص: Purpose: To examine changes in rural and urban Veterans' utilization of acute inpatient care in Veterans Health Administration (VHA) and non-VHA hospitals following access expansion from the Veterans Choice Act, which expanded eligibility for VHA-paid community hospitalization.
Methods: Using repeated cross-sectional data of VHA enrollees' hospitalizations in 9 states (AZ, CA, CT, FL, LA, MA, NY, PA, and SC) between 2012 and 2017, we compared rural and urban Veterans' probability of admission in VHA and non-VHA hospitals by payer over time for elective and nonelective hospitalizations using multinomial logistic regression to adjust for patient-level sociodemographic features. We also used generalized linear models to compare rural and urban Veterans' travel distances to hospitals.
Findings: Over time, the probability of VHA-paid community hospitalization increased more for rural Veterans than urban Veterans. For elective inpatient care, rural Veterans' probability of VHA-paid admission increased from 2.9% (95% CI 2.6%-3.2%) in 2012 to 6.5% (95% CI 5.8%-7.1%) in 2017. These changes were associated with a temporal trend that preceded and continued after the implementation of the Veterans Choice Act. Overall travel distances to hospitalizations were similar over time; however, the mean distance traveled decreased from 39.2 miles (95% CI 35.1-43.3) in 2012 to 32.3 miles (95% CI 30.2-34.4) in 2017 for rural Veterans receiving elective inpatient care in VHA-paid hospitals.
Conclusions: Despite limited access to rural hospitals, these data demonstrate an increase in rural Veterans' use of non-VHA hospitals for acute inpatient care and a small reduction in distance traveled to elective inpatient services.
(Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)

المؤلفون: Cho H; Department of Research and Development, GC Biopharma, Yongin, South Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea., Yoo KY; Korea Hemophilia Foundation, Seoul, South Korea., Shin JY; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea; School of Pharmacy, Sungkyunkwan University, Suwon, South Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea., Lee EK; Department of Research and Development, GC Biopharma, Yongin, South Korea., Choi B; Department of Research and Development, GC Biopharma, Yongin, South Korea; Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea. Electronic address: b.choi@gccorp.com.

المصدر: Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2024 Jun; Vol. 22 (6), pp. 1640-1648. Date of Electronic Publication: 2024 Feb 22.

نوع المنشور: Journal Article; Comparative Study

بيانات الدورية: Publisher: Elsevier Country of Publication: England NLM ID: 101170508 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1538-7836 (Electronic) Linking ISSN: 15387836 NLM ISO Abbreviation: J Thromb Haemost Subsets: MEDLINE

مواضيع طبية MeSH: Antibodies, Monoclonal, Humanized*/adverse effects , Antibodies, Monoclonal, Humanized*/therapeutic use , Thrombosis*/chemically induced , Thrombosis*/epidemiology , Antibodies, Bispecific*/adverse effects , Factor VIII*/adverse effects , United States Food and Drug Administration* , Adverse Drug Reaction Reporting Systems*, Humans ; United States ; Hemophilia A/drug therapy ; Hemophilia A/blood ; Risk Factors ; Coagulants/adverse effects ; Coagulants/therapeutic use ; Risk Assessment ; Databases, Factual

مستخلص: Background: Relatively little is known about thrombotic adverse events (AEs) of emicizumab in postmarketing real-world settings, particularly in comparison with factor VIII (FVIII) products. A recent European study reported a potentially greater thrombotic risk of emicizumab compared with FVIII products.
Objectives: This drug safety study aims to investigate whether thrombotic AEs are more frequently reported for emicizumab than for FVIII products and if so, whether it is independent of bypassing agents as coreporting drugs using the United States Food and Drug Administration Adverse Event Reporting System data.
Methods: Disproportionality analyses for thrombotic AEs of emicizumab vs FVIII products were conducted. Three signal detection indicators were used: proportional reporting ratio (PRR), reporting odds ratio (ROR), and informational component (IC).
Results: During 2018-2022, the proportions of thrombotic AEs among all AEs were 4.07% (97 out of 2383) and 1.44% (134 out of 9324) for emicizumab and FVIII products, respectively: PRR = 2.83 (2.19-3.66), ROR = 2.91 (2.23-3.79), and IC = 1.04 (0.70-1.28). Bypassing agents as coreporting drugs were identified in 36% and 15% of the total thrombotic AE reports associated with emicizumab and FVIII products, respectively. Even after thrombotic AE reports with bypassing agents were excluded, the reporting proportion of thrombotic AEs was still greater for emicizumab than for FVIII products: PRR = 2.19 (1.60-2.99).
Conclusion: Thrombotic AEs in the United States Food and Drug Administration Adverse Event Reporting System data were about 3 times more frequently reported for emicizumab than for FVIII products. More research and efforts in the future are warranted for monitoring, elucidating, and preventing the potential risk of thrombotic AEs in hemophilia therapy, including emicizumab.
Competing Interests: Declaration of competing interests H.C., B.C., and E.L. are employees of GC Biopharma, a biopharmaceutical company, South Korea. There were no AEs of FVIII products of GC Biopharma in the FAERS data. Other authors have competing interests to disclose.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

المؤلفون: O'Shea AMJ; VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.; Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Gibson M; Department of Human Physiology, University of Iowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA., Merchant J; Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA., Rewerts K; Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA., Miell K; Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA., Kaboli PJ; VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.; Center for Access and Delivery Research and Evaluation (CADRE), The Iowa City VA Healthcare System, Iowa City, Iowa, USA.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Shimada SL; Center for Healthcare Organization and Implementation Research (CHOIR), The Bedford VA Medical Center, Bedford, Massachusetts, USA.; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.; Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.

المصدر: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2024 Jun; Vol. 40 (3), pp. 438-445. Date of Electronic Publication: 2023 Nov 07.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Blackwell Country of Publication: England NLM ID: 8508122 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1748-0361 (Electronic) Linking ISSN: 0890765X NLM ISO Abbreviation: J Rural Health Subsets: MEDLINE

مواضيع طبية MeSH: Veterans*/statistics & numerical data , Veterans*/psychology , Telemedicine*/statistics & numerical data , Telemedicine*/standards , Rural Population*/statistics & numerical data , Urban Population*/statistics & numerical data , Patient Preference*/statistics & numerical data , Internet Access*/statistics & numerical data , United States Department of Veterans Affairs*/organization & administration , United States Department of Veterans Affairs*/statistics & numerical data, Humans ; Male ; Female ; Middle Aged ; United States ; Aged ; Adult ; Surveys and Questionnaires ; Health Services Accessibility/statistics & numerical data ; Health Services Accessibility/standards

مستخلص: Background: The expansion of telemedicine (e.g., telephone or video) in the Veterans Health Administration (VA) raises concerns for health care disparities between rural and urban veterans. Factors impeding telemedicine use (e.g., broadband, digital literacy, age) disproportionally affect rural veterans.
Purpose: To examine veteran-reported broadband access, internet use, familiarity with, and preferences for telemedicine stratified by residential rurality.
Methods: Three hundred fifty veterans with a VA primary care visit in March 2022 completed a 30-min computer-assisted telephone interview. The sampling design stratified veterans by residential rurality (i.e., rural or urban) and how primary care was delivered (i.e., in-person or by video). Counts and weighted percentages are reported.
Findings: After accounting for survey weights, 96.2% of respondents had in-home internet access and 89.5% reported functional connection speeds. However, rural- compared to urban-residing veterans were less likely to experience a telemedicine visit in the past year (74.1% vs. 85.2%; p = 0.02). When comparing telemedicine to in-person visits, rural versus urban-residing veterans rated them not as good (45.3% vs. 36.8%), just as good (51.1% vs. 53.1%), or better (3.5% vs. 10.0%) (p = 0.05). To make telemedicine visits easier, veterans, regardless of where they lived, recommended technology training (46.4%), help accessing the internet (26.1%), or provision of an internet-enabled device (25.9%).
Conclusions: Though rural-residing veterans were less likely to experience a telemedicine visit, the same actionable facilitators to improve telemedicine access were reported regardless of residential rurality. Importantly, technology training was most often recommended. Policy makers, patient advocates, and other stakeholders should consider novel initiatives to provide training resources.
(Published 2023. This article is a U.S. Government work and is in the public domain in the USA. The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)

المؤلفون: Ball DD; Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA., Sadler AG; Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA.; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Steffen MJ; Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA., Paez MB; Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA., Mengeling MA; Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA.; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.

المصدر: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2024 Jun; Vol. 40 (3), pp. 430-437. Date of Electronic Publication: 2023 Nov 09.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Blackwell Country of Publication: England NLM ID: 8508122 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1748-0361 (Electronic) Linking ISSN: 0890765X NLM ISO Abbreviation: J Rural Health Subsets: MEDLINE

مواضيع طبية MeSH: Veterans*/psychology , Veterans*/statistics & numerical data , Qualitative Research* , Rural Population*/statistics & numerical data , Decision Making* , United States Department of Veterans Affairs*/organization & administration , United States Department of Veterans Affairs*/statistics & numerical data, Humans ; Middle Aged ; Male ; Female ; Adult ; Aged ; United States ; Interviews as Topic/methods

مستخلص: Purpose: Since the Choice Act in 2014, many Veterans have had greater options for seeking Veteran Affairs (VA)-purchased care in the community. We investigated factors that influence rural Veterans' decisions regarding where to seek care.
Methods: We utilized semi-structured telephone interviews to query Veterans living in rural or highly rural areas of Midwestern states about their health care options, preferences, and experiences. Interviews were recorded and transcribed, thematically coded, and deductively analyzed using a socioecological approach.
Findings: Forty rural Veterans (20 men/20 women) ages 28-76 years completed interviews in 2019. We found that rural Veterans often spoke about their relationships and interactions with providers as an important factor in deciding where to seek care. They expressed three socioecological qualities of patient-provider relationships that affected their decisions: (1) personal level-rural Veterans traveled longer distances for more compatible patient-provider relationships; (2) interpersonal level-they sought stable patient-provider relationships that encouraged familiarity, trust, and communication; and (3) organizational level-they emphasized shared identities and expertise that fostered a sense of belonging with their provider. Participants also described how impersonal interactions, status differences, and staff turnover impacted their choice of provider and were disruptive to patient-provider relationships.
Conclusions: Rural Veterans' interview responses suggest exploring innovative ways to measure socioecological dimensions (i.e., personal, interpersonal, and organizational) of access-related decisions and patient-provider relationships to better understand health care barriers and needs. Such measures align with the VA's Whole Health approach that emphasizes person-centered care and the value of social relationships to Veterans' health.
(Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)

المؤلفون: Dickson RP; Washtenaw County Tuberculosis Program, Ypsilanti, Michigan.; University of Michigan Medical School, Ann Arbor., Dingell DA; US House of Representatives, Washington, DC.

المصدر: JAMA [JAMA] 2024 May 28; Vol. 331 (20), pp. 1703-1704.

نوع المنشور: Case Reports; Journal Article

بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE

مواضيع طبية MeSH: Government Regulation* , United States Food and Drug Administration*/legislation & jurisprudence , United States Food and Drug Administration*/standards , Bone Transplantation*/adverse effects , Bone Transplantation*/standards , Bone and Bones*/microbiology , Bone and Bones*/surgery , Tuberculosis*/epidemiology , Tuberculosis*/etiology , Tuberculosis*/microbiology , Disease Outbreaks*, Humans ; Cell- and Tissue-Based Therapy/adverse effects ; Cell- and Tissue-Based Therapy/standards ; Tissue Banks/legislation & jurisprudence ; Tissue Banks/standards ; United States/epidemiology ; Mycobacterium tuberculosis/isolation & purification ; Female ; Middle Aged

المؤلفون: Resnik J; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA., Miller CJ; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA.; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA., Roth CE; VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA.; Boston VA Research Institute (BVARI), Boston, MA 02130, USA., Burns K; VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA.; Emmanuel College, Boston, MA 02115, USA., Bovin MJ; VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA.; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA.

المصدر: Military medicine [Mil Med] 2024 May 18; Vol. 189 (5-6), pp. 1303-1311.

نوع المنشور: Systematic Review; Journal Article

بيانات الدورية: Publisher: Oxford University Press Country of Publication: England NLM ID: 2984771R Publication Model: Print Cited Medium: Internet ISSN: 1930-613X (Electronic) Linking ISSN: 00264075 NLM ISO Abbreviation: Mil Med Subsets: MEDLINE

مواضيع طبية MeSH: Stress Disorders, Post-Traumatic*/therapy , Stress Disorders, Post-Traumatic*/psychology , Veterans*/psychology , Veterans*/statistics & numerical data , Health Services Accessibility*/standards , Health Services Accessibility*/statistics & numerical data , United States Department of Veterans Affairs*/organization & administration , United States Department of Veterans Affairs*/statistics & numerical data, Humans ; United States ; Mental Health Services/statistics & numerical data ; Mental Health Services/standards

مستخلص: Introduction: Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation.
Materials and Methods: We conducted a systematic review of PubMed and PTSDpubs between May 2019 and January 2022 to identify DVA access interventions for veterans with PTSD not engaged in DVA mental health care. We identified 17 interventions and 29 manuscripts reporting quantitative access outcomes. We categorized interventions into four major categories: Primary care mental health integration, other national initiatives, telemental health, and direct outreach. We evaluated five outcome domains: Binary attendance, number of sessions attended, wait time, number of patients seen, and care initiation. We assessed the risk of bias using the Cochrane Collaboration criteria.
Results: Across articles, binary attendance generally improved, whereas the impact on the number of sessions attended was equivocal. Overall, the number of patients seen increased compared to control participants and retrospective data. The few articles that examined care initiation had mixed results. Only one article examined the impact on wait time.
Conclusions: Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
(Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

المؤلفون: Germain A; NOCTEM, LLC, Pittsburgh, PA 15213, USA., Wolfson M; NOCTEM, LLC, Pittsburgh, PA 15213, USA., Klenczar B; University of Nevada, Las Vegas, Nevada, School of Public Health, Las Vegas, NV 89119, USA., Brock MS; Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, USA., Hearn H; Carl R. Darnall Army Medical Center, Sleep Disorder Center, Fort Hood, TX 76544, USA., O'Reilly B; Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA., Blue Star J; Hanscom Air Force Base, Bedford, MA 01730, USA., Mysliwiec V; Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.

المصدر: Military medicine [Mil Med] 2024 May 18; Vol. 189 (5-6), pp. e1089-e1097.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Oxford University Press Country of Publication: England NLM ID: 2984771R Publication Model: Print Cited Medium: Internet ISSN: 1930-613X (Electronic) Linking ISSN: 00264075 NLM ISO Abbreviation: Mil Med Subsets: MEDLINE

مواضيع طبية MeSH: Sleep Initiation and Maintenance Disorders*/therapy , Sleep Initiation and Maintenance Disorders*/psychology , United States Department of Defense*/organization & administration , United States Department of Defense*/statistics & numerical data, Humans ; United States ; Surveys and Questionnaires ; Behavioral Medicine/methods ; Behavioral Medicine/statistics & numerical data ; Behavioral Medicine/standards ; Military Personnel/statistics & numerical data ; Military Personnel/psychology ; Male ; Adult ; Cognitive Behavioral Therapy/methods ; Cognitive Behavioral Therapy/statistics & numerical data ; Cognitive Behavioral Therapy/standards ; Female

مستخلص: Introduction: Insomnia affects approximately 40% of active duty service members and adversely affects health, readiness, and safety. The VA/DoD Clinical Practice Guideline for the management of insomnia recommends cognitive-behavioral treatment of insomnia (CBTI) or its abbreviated version (brief behavioral treatment of insomnia [BBTI]) as the first-line insomnia treatment. The goal of this study was to assess CBTI/BBTI resources at MTFs, perceived facilitators and barriers for CBTI/BBTI, and gaps in these treatments across the Defense Health Agency.
Materials and Methods: Between July and October 2022, we conducted an electronic survey of CBTI/BBTI resources across Contiguous United States and the District of Columbia (CONUS) and Outside Continental United States (OCONUS) MTFs. The survey was distributed to 154 military sleep health care providers from 32 MTFs, and a link to the survey was posted on two online military sleep medicine discussion forums. Fifteen providers from 12 MTFs volunteered to complete a 30-minute qualitative interview to explore their perception of barriers and facilitators of CBTI/BBTI at their facility.
Results: Fifty-two of 154 providers (33.8%) at 20 MTFs completed the survey. A majority of providers indicated that hypnotics remain the most common treatment for insomnia at their facility. Sixty-eight percent reported that CBTI/BBTI was available at their facility and estimated that less than 50% of the patients diagnosed with insomnia receive CBTI/BBTI. The main facilitators were dedicated, trained CBTI/BBTI providers and leadership support. Referrals to the off-post civilian network and self-help apps were not perceived as significant facilitators for augmenting insomnia care capabilities. The primary barriers to offering CBTI/BBTI were under-resourced clinics to meet the high volume of patients presenting with insomnia and scheduling and workflow limitations that impede repeated treatment appointments over the period prescribed by CBTI/BBTI protocols. Four primary themes emerged from qualitative interviews: (1) CBTI/BBTI groups can scale access to insomnia care, but patient engagement and clinical outcomes are perceived as inferior to individual treatment; (2) embedding trained providers in primary or behavioral health care could accelerate access, before escalation and referral to a sleep clinic; (3) few providers have the time to adhere to traditional CBTI protocols, and appointment scheduling often does not support weekly or bi-weekly treatment visits; and (4) the absence of quality and/or continuity of care measures dampens providers' enthusiasm for using external referral resources or self-help apps.
Conclusions: Although there is a wide recognition that CBTI/BBTI is the first-line recommended insomnia treatment, the limited scalability of treatment protocols, clinical workflow limitations, and scarcity of trained CBTI/BBTI providers limit the implementation of the VA/DoD clinical guideline. Educating and engaging health care providers and leadership about CBTI, augmenting CBTI-dedicated resources, and adapting clinical workflows were identified as specific strategies needed to meet the current insomnia care needs of service members. Developing protocols for scaling the availability of CBTI expertise at diverse points of care, upstream from the sleep clinics, could accelerate access to care. Establishing standardized quality measures and processes across points of care, including for external providers and self-help apps, would enhance providers' confidence in the quality of insomnia care offered to service members.
(Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)