scholarly journals Sexual health assessment as part of a whole health model to care: Improving communication and technological barriers

2021 ◽  
Author(s):  
Alex Uzdavines ◽  
Drew Helmer ◽  
Juliette Spelman ◽  
Kristin Mattocks ◽  
Amanda M Johnson ◽  
...  
Keyword(s):  
Sexual Health ◽  
Health Assessment ◽  
Well Being ◽  
Educational Interventions ◽  
Routine Care ◽  
Veterans Health ◽  
Health Administration ◽  
Future System ◽  
Health Model ◽  
And Gender

Sexual health is the state of well-being regarding one’s sexuality, not just the absence of disease or dysfunction. Sexual health is highly valued by most people and associated with overall health. Assessment of sexual health, including sexual orientation and gender identity, should be integrated into the whole health approach to care. Addressing sexual health will enhance preventive care, promote healthy sexual functioning, and optimize overall health and well-being.Unfortunately, sexual health is not routinely assessed in clinical practice. One of the primary barriers is a gap in communication between patients and providers. Providers cite beliefs that patients will bring up sexual concerns themselves, or that patients might be offended by discussing sexual health. By contrast, patients often report an expectation that providers will bring up sexual health, and be comfortable with sexual health discussions in the clinic setting.Within the Veterans Health Administration (VHA), the lack of a sexual health template within the electronic health record (EHR) adds an additional technological barrier. The VHA’s transition toward whole health and updates to its EHR will provide unique opportunities to integrate sexual health assessment into routine care. We highlight future system modifications to address this within the VHA.Given the multifaceted barriers to sexual health assessment, it will be vital for healthcare systems integrating a whole health approach to develop both practical and educational interventions to address the communication gap. VHA’s expertise in developing and implementing EHR-based quality improvements and health education interventions may help inform interventions beyond VHA.

scholarly journals Veterans Health Administration’s Whole Health System of Care: Supporting the Health, Well-Being, and Resiliency of Employees

2021 ◽  
Vol 10 ◽  
pp. 216495612110226
Author(s):  
Kavitha P Reddy ◽  
Tamara M Schult ◽  
Alison M Whitehead ◽  
Barbara G Bokhour
Keyword(s):  
Health System ◽  
Care Delivery ◽  
Health Planning ◽  
Well Being ◽  
Employee Health ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Centered ◽  
Foundational Work ◽  
Health And Well Being

The Veterans Health Administration (VHA) is implementing a Whole Health System (WHS) of care that empowers and equips Veterans to take charge of their health and well-being and live their lives to the fullest, and increasingly leaders recognize the need and value in implementing a similar approach to support the health and well-being of employees. The purpose of this paper is to do the following: 1) provide an overview of the WHS of care in VHA and applicability in addressing employee resiliency; 2) provide a brief history of employee well-being efforts in VHA to date; 3) share new priorities from VHA leadership as they relate to Employee Whole Health strategy and implementation; and 4) provide a summary of the impacts of WHS of care delivery on employees. The WHS of care utilizes all therapeutic, evidence-based approaches to support self-care goals and personal health planning. Extending these approaches to employees builds upon 10 years of foundational work supporting employee health and well-being in VHA. In 2017, one facility in each of the 18 Veterans Integrated Service Networks (VISNs) in VHA was selected to participate in piloting the WHS of care with subsequent evaluation by VA’s Center for Evaluating Patient-Centered Care (EPCC). Early outcomes, from an employee perspective, suggest involvement in the delivery of the WHS of care and personal use of the whole health approach have a meaningful impact on the well-being of employees and how they experience the workplace. During the COVID-19 pandemic, VHA has continued to support employees through virtual resources to support well-being and resiliency. VHA's shift to this patient-centered model is supporting not only Veteran care but also employee health and well-being at a time when increased support is needed.

Abstract 13412: Electronic Consultation for the Management of Atrial Fibrillation is Associated With Higher Healthcare Costs

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Evan S Manning ◽  
Melanie D Whittington ◽  
Susan R Kirsh ◽  
Rachael Kenney ◽  
Jeffrey ToddStenberg ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Language Processing ◽  
Healthcare Costs ◽  
National Sample ◽  
Veterans Health ◽  
Health Administration ◽  
Electronic Consultation ◽  
Consult Group ◽  
Facility Level ◽  
And Gender

Introduction: A study of 42,000 cardiology consults within the Veterans Health Administration (VHA) in 2016 found that patients who received electronic consultation (e-consults) had similar healthcare costs at 6 months compared to those who received face-to-face (F2F) consults. However, results may have been confounded if patients with less costly conditions received e-consults. Our aim was to compare costs between those receiving F2F vs. e-consults for a similar indication. Hypothesis: Electronic rather than F2F consultation for atrial fibrillation (AF) management will be associated with lower total healthcare costs. Methods: We conducted a retrospective cohort study of a national sample of VHA patients who received cardiology consultation in 2016. We used a natural language processing script to identify consults for AF management. Primary outcomes were total healthcare costs at 3 and 6 months. Secondary outcomes included inpatient and outpatient costs. We compared costs between groups using a generalized linear model with a gamma distribution and log link. We adjusted for community wage and Charlson comorbidity indices, distance to nearest facility, age, and gender. Standard errors were clustered at the facility level. Results: We sampled 176 F2F and 136 e-consults from 43 facilities. Mean total 6-month costs were $12,928 (95% confidence interval [CI]: 1,377; 40,644) and $8,286 (95% CI: 959; 31,320) among e-consult and F2F groups, respectively. The e-consult group had 12.3% higher 3-month (p<0.001) and 41.5% higher 6-month total healthcare costs (p<0.001) in comparison to the F2F group. At 3 months, the e-consult group had 25.1% lower inpatient costs (p<0.001) and 32.5% higher outpatient costs (p<0.001). At 6 months, the e-consult group had 6.3% higher inpatient costs (p<0.001) and 48.4% higher outpatient costs (p<0.001). Conclusions: Use of e-consults for AF management is associated with reduced inpatient costs at 3 months, but higher total costs, which were largely driven by outpatient costs. Improving our understanding of healthcare utilization after initial consultation, or in differences in reasons for consultation within AF management may help explain these differences.

scholarly journals Cisgenderism and transphobia in sexual health care and associations with testing for HIV and other sexually transmitted infections: Findings from the Australian Trans & Gender Diverse Sexual Health Survey

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253589
Author(s):  
Shoshana Rosenberg ◽  
Denton Callander ◽  
Martin Holt ◽  
Liz Duck-Chong ◽  
Mish Pony ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Well Being ◽  
Community Based ◽  
Sexual Health Care ◽  
Sti Testing ◽  
Gender Diverse ◽  
And Gender ◽  
Community Based Services ◽  
Health And Well Being

Transgender and gender diverse people have unique risks and needs in the context of sexual health, but little is known about sexual health care for this population. In 2018, a national, online survey of sexual health and well-being was conducted with trans and gender diverse people in Australia (n = 1,613). Data from this survey were analysed to describe uptake of sexual health care and experiences of interpersonal and structural cisgenderism and transphobia. Experiences of cisgenderism and transphobia in sexual health care were assessed using a new, four-item scale of ‘gender insensitivity’, which produced scores ranging from 0 (highly gender sensitive) to 4 (highly gender insensitive). Logistic and linear regression analyses were conducted to determine if experiences of gender insensitivity in sexual health care were associated with uptake and frequency of HIV/STI testing in the 12 months prior to participation. Trans and gender diverse participants primarily accessed sexual health care from general practice clinics (86.8%), followed by publicly funded sexual health clinics (45.6%), community-based services (22.3%), and general hospitals (14.9%). Experiences of gender insensitivity were common overall (73.2% of participants reported ≥2 negative experiences) but most common in hospitals (M = 2.9, SD = 1.3) and least common in community-based services (M = 1.3, SD = 1.4; p<0.001). When controlling for sociodemographic factors, social networks, general access to health care, and sexual practices, higher levels of gender insensitivity in previous sexual health care encounters were associated with a lower likelihood of recent HIV/STI testing (adjusted prevalence ratio = 0.92, 95% confidence interval [CI]:091,0.96, p<0.001) and less-frequent HIV/STI testing (B = -0.07, 95%CI:-0.10,-0.03, p = 0.007). Given the high rates of HIV and other STIs among trans and gender diverse people in Australia and overseas, eliminating cisgenderism and transphobia in sexual health care may help improve access to diagnostic testing to reduce infection rates and support the overall sexual health and well-being of these populations.

scholarly journals Sexual Health and COVID-19: Protocol for a Living Scoping Review

2020 ◽  
Author(s):  
Navin Kumar ◽  
Kamila Janmohamed ◽  
Kate Nyhan ◽  
Laura Forastiere ◽  
Wei-Hong Zhang ◽  
...  
Keyword(s):  
Sexual Health ◽  
Scoping Review ◽  
Minority Groups ◽  
Current Knowledge ◽  
Well Being ◽  
Bibliographic Databases ◽  
Original Research ◽  
Study Selection ◽  
Scoping Reviews ◽  
And Gender

Abstract Background: Global responses to the COVID-19 pandemic have exposed and exacerbated existing socioeconomic and health inequities that disproportionately affect the sexual health and well-being of many populations, including people of color, ethnic minority groups, women, and sexual and gender minority populations. Although there have been several reviews published on COVID-19 and health disparities across various populations, none have focused on sexual health. We plan to conduct a scoping review that seeks to fill several of the gaps in the current knowledge of sexual health in the COVID-19 era and facilitate multi-country comparisons.Methods: A scoping review focusing on sexual health and COVID-19 will be conducted. Multiple bibliographic databases will be searched. Study selection will conform to Joanna Briggs Institute Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews. Data will be used to inform multi-country comparisons.Results: N/AConclusions: Original research is urgently needed to mitigate the risks of COVID-19 on sexual health. The planned scoping review will help to address this gap and contribute to multi-country comparisons as part of the I-SHARE network.Systematic Review registrations: N/A

scholarly journals Sexual health and COVID-19: Protocol for a scoping review

2020 ◽  
Author(s):  
Navin Kumar ◽  
Kamila Janmohamed ◽  
Kate Nyhan ◽  
Laura Forastiere ◽  
Wei-Hong Zhang ◽  
...  
Keyword(s):  
Sexual Health ◽  
Scoping Review ◽  
Minority Groups ◽  
Current Knowledge ◽  
Well Being ◽  
Bibliographic Databases ◽  
Original Research ◽  
Study Selection ◽  
Scoping Reviews ◽  
And Gender

Abstract Background: Global responses to the COVID-19 pandemic have exposed and exacerbated existing socioeconomic and health inequities that disproportionately affect the sexual health and well-being of many populations, including people of color, ethnic minority groups, women, and sexual and gender minority populations. Although there have been several reviews published on COVID-19 and health disparities across various populations, none have focused on sexual health. We plan to conduct a scoping review that seeks to fill several of the gaps in the current knowledge of sexual health in the COVID-19 era and facilitate multi-country comparisons.Methods: A scoping review focusing on sexual health and COVID-19 will be conducted. Multiple bibliographic databases will be searched. Study selection will conform to Joanna Briggs Institute Reviewers’ Manual 2015 Methodology for JBI Scoping Reviews. Data will be used to inform multi-country comparisons.Conclusions: Original research is urgently needed to mitigate the risks of COVID-19 on sexual health. The planned scoping review will help to address this gap and contribute to multi-country comparisons.

“Asking Is Never Bad, I Would Venture on That”: Patients’ Perspectives on Routine Pain Screening in VA Primary Care

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2163-2171
Author(s):  
Karleen F Giannitrapani ◽  
Marie C Haverfield ◽  
Natalie K Lo ◽  
Matthew D McCaa ◽  
Christine Timko ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Systems ◽  
Routine Care ◽  
Veterans Health ◽  
Health Administration ◽  
Psychological Pain ◽  
Patient Recall ◽  
Semistructured Interviews ◽  
Care Systems ◽  
Screening Assessment

Abstract Objective Screening for pain in routine care is one of the efforts that the Veterans Health Administration has adopted in its national pain management strategy. We aimed to understand patients’ perspectives and preferences about the experience of being screened for pain in primary care. Design Semistructured interviews captured patient perceptions and preferences of pain screening, assessment, and management. Subjects We completed interviews with 36 patients: 29 males and seven females ranging in age from 28 to 94 years from three geographically distinct VA health care systems. Methods We evaluated transcripts using constant comparison and identified emergent themes. Results Theme 1: Pain screening can “determine the tone of the examination”; Theme 2: Screening can initiate communication about pain; Theme 3: Screening can facilitate patient recall and reflection; Theme 4: Screening for pain may help identify under-reported psychological pain, mental distress, and suicidality; Theme 5: Patient recommendations about how to improve screening for pain. Conclusion Our results indicate that patients perceive meaningful, positive impacts of routine pain screening that as yet have not been considered in the literature. Specifically, screening for pain may help capture mental health concerns that may otherwise not emerge.

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