Browsing by Subject "veterans"
Now showing 1 - 11 of 11
Results Per Page
Sort Options
Item Open Access Comprehensive Family Caregiver Support and Caregiver Well-Being: Preliminary Evidence From a Pre-post-survey Study With a Non-equivalent Control Group.(Frontiers in public health, 2019-01) Smith, Valerie A; Lindquist, Jennifer; Miller, Katherine EM; Shepherd-Banigan, Megan; Olsen, Maren; Campbell-Kotler, Margaret; Henius, Jennifer; Kabat, Margaret; Van Houtven, Courtney HaroldIntroduction: In May 2010, the Caregivers and Veterans Omnibus Health Services Act of 2010, was signed into law in the United States, establishing the Program of Comprehensive Assistance for Family Caregivers (PCAFC) provided through the VA Caregiver Support Program (CSP). Prior to this program, over half of family caregivers reported being untrained for the tasks they needed to provide. The training through PCAFC represents the largest effort to train family caregivers in the U.S., and the features of the program, specifically a monthly stipend to caregivers and access to a Caregiver Support Coordinator at each VA medical center nationally, make it the most comprehensive caregiver support program ever enacted in the U.S. Methods: The purpose of this study is to examine the association between PCAFC participation and caregiver well-being following enrollment, comparing participating PCAFC caregivers to caregivers who applied to but were not approved for PCAFC participation (non-participants). Well-being is defined using three diverse but related outcomes: depressive symptoms, perceived financial strain, and perceived quality of the Veteran's health care. Additional well-being measures also examined include the Zarit Burden Inventory and positive aspects of caregiving. Results: The survey sample comprised of 92 caregivers approved for PCAFC and 66 caregivers not approved. The mean age of responding caregivers was 45; over 90% of caregivers were female; and over 80% of caregivers were married in both groups. We find promising trends in well-being associated with PCAFC participation. First, the perception of financial strain declined among participants compared to non-participants. Second, while depressive symptoms did not improve for the PCAFC caregivers, depressive symptoms increased among non-participants. Third, perceived quality of the Veteran's VA healthcare was no different between participants and non-participants. However, the 158 returned surveys reflect only a 5% response rate; hence this evidence is preliminary. Conclusion: Despite cautioning that results be interpreted as preliminary, this study provides unique descriptive information about young caregivers of U.S. post-9/11 Veterans, and offers a first step in filling the evidence gap about how comprehensive caregiver support in the U.S. may affect caregiver well-being. These preliminary findings should be explored and validated in a larger sample.Item Open Access Developing Predictors of Long-Term Adherence to Exercise Among Older Veterans and Spouses.(Journal of applied gerontology : the official journal of the Southern Gerontological Society, 2019-09-21) Brown, Candace S; Sloane, Richard; Morey, Miriam CBehavior change theory was used to explore predictors of long-term adherence (≥2 years) to exercise. A retrospective analysis of data from participants (N = 97) who reached a 6-month follow-up, which served as the baseline, was evaluated for completion of yearly follow-up surveys. Variables examined at baseline, which included age, race, gender, body mass index (BMI), and self-report of comorbidities, symptoms, physical function, and a Barriers Specific Self-Efficacy Scale, were examined with significance set at p < .05. Lower BMI (29.1 ± 5.1 vs. 31.6 ± 6.5, p = .047) and higher self-efficacy to overcome environmental barriers (p = .016) and social isolation (p = .05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers, such as inclement weather, access to exercise site, and opportunities for group-based exercise, should be addressed to promote long-term adherence to exercise among older adults.Item Open Access Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis.(JMIR formative research, 2022-07) Ma, Jessica E; Grubber, Janet; Coffman, Cynthia J; Wang, Virginia; Hastings, S Nicole; Allen, Kelli D; Shepherd-Banigan, Megan; Decosimo, Kasey; Dadolf, Joshua; Sullivan, Caitlin; Sperber, Nina R; Van Houtven, Courtney HBackground
Most efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers.Objective
Few health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers.Methods
We selected EHR home- and community-based referrals suggestive of veterans' need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening.Results
During the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver.Conclusions
The EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers.Trial registration
ClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380.Item Open Access Linkage between theory-based measurement of organizational readiness for change and lessons learned conducting quality improvement-focused research.(Learning health systems, 2017-04) Jackson, George L; Roumie, Christianne L; Rakley, Susan M; Kravetz, Jeffrey D; Kirshner, Miriam A; Del Monte, Pamela S; Bowen, Michael E; Oddone, Eugene Z; Weiner, Bryan J; Shaw, Ryan J; Bosworth, Hayden BOrganizations have different levels of readiness to implement change in the patient care process. The Hypertension Telemedicine Nurse Implementation Project for Veterans (HTN-IMPROVE) is an example of an innovation that seeks to enhance delivery of care for patients with hypertension. We describe the link between organizational readiness for change (ORC), assessed as the project began, and barriers and facilitators occurring during the process of implementing a primary care innovation. Each of 3 Veterans Affairs medical centers provided a half-time nurse and implemented a nurse-delivered, telephone-based self-management support program for patients with uncontrolled hypertension. As the program was starting, we assessed the ORC and factors associated with ORC. On the basis of consensus of medical center and research partners, we enumerated implementation process barriers and facilitators. The primary ORC barrier was unclear long-term commitment of nursing to provide continued resources to the program. Three related barriers included the need to address: (1) competing organizational demands, (2) differing mechanisms to integrate new interventions into existing workload, and (3) methods for referring patients to disease and self-management support programs. Prior to full implementation, however, stakeholders identified a high level of commitment to conduct nurse-delivered interventions fully using their skills. There was also a significant commitment from the core implementation team and a desire to improve patient outcomes. These facilitators were observed during the implementation of HTN-IMPROVE. As demonstrated by the link between barriers to and facilitators of implementation anticipated though the evaluation of ORC and what was actually observed during the process of implementation, this project demonstrates the practical utility of assessing ORC prior to embarking on the implementation of significant new clinical innovations.Item Open Access Measuring sustainability of a grassroots program in a large integrated health care delivery system: the Warrior to Soul Mate Program.(Journal of military, veteran and family health, 2018-01) Stolldorf, Deonni P; Fortune-Britt, Alice G; Nieuwsma, Jason A; Gierisch, Jennifer M; Datta, Santanu K; Angel, Clyde; Millspaugh, Dick D; Jackson, George LIntroduction:Veterans experience many physical and psychosocial adjustment problems that challenge personal relationships and social functioning and successful social reintegration. The Warrior to Soul Mate (W2SM) program uses a structured curriculum [i.e., the Practical Application of Intimate Relationships Skills (PAIRS)] to address veterans' interpersonal needs by teaching participants effective interpersonal skills. Veterans who attended the W2SM program reported lower anxiety levels, improvements in marital alterations and satisfaction, and increased intimacy, cohesion, and affection. Therefore, sustaining the W2SM program can have long-term positive effects for veterans, families, and the greater society. The purpose of this paper is to describe the sustainability of the W2SM program. Methods:The Model of Community-based Program Sustainability conceptually guided the evaluation. Twenty-three VA hospitals in the U.S. that offer W2SM programs completed a self-report survey to measure sustainability. Results:The highest scoring sustainability elements were "Demonstrating program results" (M=5.82, SD=1.23), "Staff involvement and integration" (M= 5.79, SD= 1.34), and "Program responsivity" (M=4.39, SD= 1.16); the lowest scoring element was "Strategic funding" (M=2.78, SD=1.75). Statistically significant associations were found between the global middle-range program results and three sustainability elements: leadership competence (r = .472, p = .023), effective collaboration (r = .470, p = .024), and strategic funding (r = .507, p = .014). Discussion:Efforts to sustain programs should focus on leaders planning for sustainability at the onset of program implementation, collaborators must be involved in program design, implementation and evaluation, and long-term funding sources must be secured to support program operations and continuation.Item Open Access Ombitasvir/paritaprevir/ritonavir and dasabuvir±ribavirin for chronic HCV infection in US veterans with psychiatric disorders.(Journal of medical virology, 2019-12) Fuchs, Michael; Monto, Alexander; Bräu, Norbert; Charafeddine, Mariem; Schmidt, Warren; Kozal, Michael; Naggie, Susanna; Cheung, Ramsey; Schnell, Gretja; Yu, Yao; Richards, Kristine; Mullally, Victoria; Cohen, Daniel E; Toro, DorisHepatitis C virus (HCV) infections are more common among US veterans receiving care through Veterans Affairs (VA) Medical Centers than among the general population. Historically, HCV therapies had lower efficacy rates in VA patients, possibly due to common comorbidities such as psychiatric disorders and substance abuse. The direct-acting antivirals ombitasvir/paritaprevir/ritonavir and dasabuvir (OBV/PTV/r+DSV)±ribavirin (RBV) are approved in the US for HCV genotype 1 (GT1)-infected adults with or without cirrhosis. This study prospectively evaluated the safety and efficacy of OBV/PTV/r+DSV±RBV in VA patients with HCV GT1 infection. TOPAZ-VA was a phase 3b, open-label trial. Adult US veterans with HCV GT1 infection, without cirrhosis or with compensated cirrhosis, were eligible for enrollment. Patients with GT1a infection received OBV/PTV/r +DSV+RBV for 12 weeks or 24 weeks (for those with cirrhosis); GT1b-infected patients without cirrhosis received OBV/PTV/r +DSV for 12 weeks; those with cirrhosis received OBV/PTV/r +DSV with RBV. The primary endpoint was sustained virologic response at posttreatment week 12 (SVR12); safety was also assessed. Ninety-nine patients were enrolled at 10 sites from May through November 2015. The majority were male (96%), white (60%), and with GT1a infection (68%); 49% reported ongoing psychiatric disorders. Overall, 94% (93/99) achieved SVR12; three patients had a virologic failure. The most common AEs were fatigue (28%), headache (20%), and nausea (15%); six patients discontinued treatment due to AEs. In US veterans with HCV GT1 infection, OBV/PTV/r +DSV±RBV yielded a 94% overall SVR12 rate and was well tolerated. The presence of psychiatric disorders and/or injection drug use did not impact efficacy.Item Open Access Patterns of Healthcare Utilization Among Veterans Infected With Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and Coinfected With HIV/HCV: Unique Burdens of Disease.(Open forum infectious diseases, 2016-09) Katrak, Shereen; Park, Lawrence P; Woods, Christopher; Muir, Andrew; Hicks, Charles; Naggie, SusannaBackground. Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and the primary cause of liver transplantation in the United States, and coinfection with human immunodeficiency virus (HIV) increases the risk of comorbidities. However, healthcare utilization (HCU) patterns among HIV/HCV-coinfected patients are poorly understood. This study compared the rates of HCU and reasons for hospital admission among HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans. Methods. Hepatitis C virus- and HIV-infected and HIV/HCV-coinfected veterans in care with the Department of Veterans Affairs (VA) from 1998 to 2009 (n = 335 371, n = 28 179, n = 13 471, respectively) were identified by HIV- and HCV-associated International Classification of Diseases, Ninth Revision codes from the clinical case registry. We assessed rates of HCU using emergency department (ED) visits, outpatient visits, and hospitalization and primary diagnoses associated with hospitalization. Independent risk factors associated with hospitalization were also examined. Results. Rates of outpatient and ED visits increased over the 11-year study period for all groups, with inpatient admission rates remaining stable. The HCU rates were consistently higher for the coinfected than other cohorts. The primary reason for hospital admission for all groups was psychiatric disease/substance use, accounting for 44% of all admissions. Nadir CD4 <350 cells/mm3 was associated with higher rates of hospitalization versus nadir CD4 >500 cells/mm3. Conclusions. As the current population of HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans age, they will continue to place a substantial and increasing demand on the US healthcare system, particularly in their utilization of ED and outpatient services. These data suggest the need for an ongoing investment in mental health and primary care within the VA healthcare system.Item Open Access Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19.(Gerontology & geriatric medicine, 2020-01) Jennings, Stephen C; Manning, Kenneth M; Bettger, Janet Prvu; Hall, Katherine M; Pearson, Megan; Mateas, Catalin; Briggs, Brandon C; Oursler, Krisann K; Blanchard, Erin; Lee, Cathy C; Castle, Steven; Valencia, Willy M; Katzel, Leslie I; Giffuni, Jamie; Kopp, Teresa; McDonald, Michelle; Harris, Rebekah; Bean, Jonathan F; Althuis, Katherine; Alexander, Neil B; Padala, Kalpana P; Abbate, Lauren M; Wellington, Toby; Kostra, James; Allsup, Kelly; Forman, Daniel E; Tayade, Arti S; Wesley, Alan D; Holder, Alice; Morey, Miriam CExercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.Item Open Access The association of resilience on psychiatric, substance use, and physical health outcomes in combat trauma-exposed military service members and veterans.(European journal of psychotraumatology, 2019-01) Sheerin, Christina M; Amstadter, Ananda B; Kurtz, Erin D; Bountress, Kaitlin E; Stratton, Kelcey J; McDonald, Scott D; Mid-Atlantic Va Mirecc WorkgroupObjective: Although Combat exposure is associated with a range of psychiatric outcomes, many veterans do not develop psychopathology. Resilience is a multifaceted construct associated with reduced risk of distress and psychopathology; however, few studies have examined the relationship of resilience with a broader spectrum of health outcomes following combat exposure. It also remains important to determine the association of resilience above and beyond other documented risk and protective factors. Method: In a sample of combat-exposed veterans (N = 1,046) deployed to Iraq and Afghanistan, we examined a quantitative method for exploring relative psychological resilience (discrepancy-based psychiatric resilience; DBPR) and tested the hypothesis that resilience would be associated with reduced risk for psychiatric diagnosis count, substance use, and physical health outcomes, above and beyond other known correlates (e.g. combat exposure, social support). Results: In the final model, results suggested an inverse association of discrepancy-based psychiatric resilience with current psychiatric diagnosis count (β = -0.57, p < .001), alcohol use (β = -0.16, p < .001), drug use (β = -0.13, p < .001), and physical health concerns (β = -0.42, p < .001) after accounting for other relevant risk and protective factors. Conclusions: Results extend the nomological net of this quantitative resilience construct to include other relevant health outcomes, and demonstrate that resilience may have more of a buffering relationship with psychiatric and physical health concerns compared to substance use outcomes.Item Open Access The Use of Evaluation Panels During the Development of a Digital Intervention for Veterans Based on Cognitive Behavioral Therapy for Insomnia: Qualitative Evaluation Study.(JMIR formative research, 2023-03) Ryan, Arthur Thomas; Brenner, Lisa Anne; Ulmer, Christi S; Mackintosh, Margaret-Anne; Greene, Carolyn JBackground
Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS).Objective
We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS.Methods
A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists' feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study.Results
The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course's sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms.Conclusions
The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers.Item Open Access Understanding the Experiences and Needs of Military-Affiliated Students at Duke(2022-06-21) Arnsberg, Emily; Psoter, JodiDuring the Spring 2022 semester, the Research and Instructional Services department at Duke University Libraries conducted a study to better understand the library and campus experiences of military-affiliated students at Duke University. Overall, this research study focused on qualitative data gathering, using two semi-structured interviews and background research in the form of a literature review to help develop recommendations. The goal of this study was to help improve Duke Libraries services and resources to better meet the unique needs of the Duke military-affiliated student population, and to better understand this group’s experiences within the Libraries. There were four themes that appeared from the two interviews and background research: one, that military-affiliated students are older than the average civilian student; two, the drive to “try it out themselves first” before asking for help; three, the heavy use of online resources, versus using the libraries physical space; and four, how the library website can be confusing when first starting out. In the end, the study highlighted six recommendations for the future (see page 12 for additional details): one, develop partnerships with campus veteran and military organizations; two, create a library orientation and tour for military-affiliated students; three, designate a military library liaison; four, publish a military student LibGuide; five, design veteran-targeted training sessions; and six, offer training for library staff.