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" Female Veterans Returning from Wars in Iraq and Afghanistan Who Screen Positive for Alcohol Misuse in the Veterans Health Administration: Predictors of Follow-Up and Completed Referral "
Pugatch, Marianne
Hodgkin, Dominic
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Latin Dissertation
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| Language of Document
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English
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| Record Number
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1051034
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| Doc. No
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TL50151
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| Main Entry
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Pugatch, Marianne
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| Title & Author
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Female Veterans Returning from Wars in Iraq and Afghanistan Who Screen Positive for Alcohol Misuse in the Veterans Health Administration: Predictors of Follow-Up and Completed Referral\ Pugatch, MarianneHodgkin, Dominic
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| College
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Brandeis University, The Heller School for Social Policy and Management
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| Date
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2019
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| Degree
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Ph.D.
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| student score
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2019
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| Note
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240 p.
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| Abstract
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Alcohol use disorders in women are preventable and treatable diseases similar to diabetes or cancer. Yet, without timely identification and engagement in treatment, alcohol use and misuse among females can have profound effects with a high disease burden. Women have unique alcohol-related risks: they metabolize alcohol differently than men, their health-related risk is dependent on lower consumption, and women of reproductive age with intended or unintended pregnancy face greater complications due to unhealthy alcohol use. For a younger cohort of female Veterans returning from wars in Iraq and Afghanistan, prevention and intervention are important because of their unique vulnerability to alcohol use disorders, health, mental health, and other harms related to any alcohol use. The Department of Veterans Affairs (VA) has adopted national policies and guidelines to reduce the consequences of alcohol misuse by requiring providers to conduct screening (2004, 2006, 2008), brief intervention (2007, 2008) and referral to treatment (2009, 2015), a three-part intervention collectively known as SBIRT. Nationally, VA alcohol screening and follow-up recommendations do not vary by gender but some local facilities alert providers of the gender-specific alcohol positive score. Since implementation, rates of follow-up have increased for Veterans. However, questions remain about the quality of implementation for female Veterans. The purpose of this study was to increase knowledge about patient-, provider- and program-level predictors of brief intervention (BI) and referral to treatment (RT) as well as predictors of completed referral to treatment for female Returning Veterans in one VA facility in the Northeast. Utilizing data from administrative sources and data abstracted from the electronic medical record, this was a retrospective observational study of a sample of female Returning Veterans who received healthcare services in one VA facility and screened positive for alcohol misuse between 2010 and 2016. Logistic regression was used to examine the patient, provider, and program characteristics that predict follow-up outcomes. In this study, the prevalence rate for alcohol misuse is 32.6%. Rates of BI, RT and completed referral are 59.9%, 41.6%, and 78% respectively. Among female Returning Veterans who screen positive for alcohol misuse, BI and any follow-up are more likely if they are screened in visits with providers (other than nurses) in mental health programs or in programs that are not gender-specific. Being seen by providers working in VA medical centers predicts higher rates of RT than being seen by providers working in community-based outpatient clinics. While female Returning Veterans with military sexual trauma are more likely to receive follow-up from providers, they are less likely to complete the referral. Younger female Returning Veterans are also less likely to complete the referral. This study builds on the existing knowledge of implementation for a cohort of female Veterans by examining rates of BI, RT, and completed referral as well as predictors and pathways to treatment. At one facility, rates of any follow-up and completed referral are relatively high. However, certain practice trends and moderate rates of BI indicate that opportunities for innovation exist—one option is to implement targeted trainings that address female Returning Veterans’ gender differences in alcohol use and unique needs for follow-up care.
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Gender studies
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Mental health
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Public policy
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Social research
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| Added Entry
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Hodgkin, Dominic
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| Added Entry
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Brandeis University, The Heller School for Social Policy and Management
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