Improving Health Care for Women Veterans

Women are now the fastest growing segment of eligible VA health care users, representing about 15% of our active duty military, 20% of our new recruits, and 17% of reserve and National Guard Forces. Women represent 5.5% of the 27 million veterans, and this number is expected to increase to 10% by 2010.1 Women veterans have their own unique health care needs, some combat related. VA has been, and continues to be, committed to making sure that women veterans receive the best available care for all of their special health care needs. Women veterans' health is a VA research priority. In 1983, VA mandated that all research studies conducted or funded by the VA include women veterans; in 1992, VA formally targeted health issues specific to women veterans as research priorities; and in the last decade, there has been an expansion of biomedical, clinical, health services, and rehabilitation research with the potential to improve the health of women veterans.2 Given all of these facts, we are very pleased to support this special issue of the Journal of General Internal Medicine focusing on original empirical studies addressing health and health care delivery issues affecting women veterans. The special issue is an outgrowth of an effort to recognize and expand the relationship between the Society of General Internal Medicine (SGIM) and VA Health Services Research and Development (HSR&D). Many VA HSR&D investigators also are members of SGIM, and just over 2 years ago an SGIM/VA workgroup was formed to expand possibilities for collaboration between the 2 groups. Chaired by Lisa Rubenstein, MD, the workgroup initiated many collaborative activities and provided the genesis for this special issue. I offer my sincere thanks to Dr. Rubenstein and all SGIM/VA workgroup members for their efforts. Special thanks to Drs. Donna Washington and Eric Bass, members who championed women's health as the topic for the special issue. We also thank Dr. Washington and Elizabeth Yano, PhD, for serving as co-editors for VA HSR&D. Much appreciation also goes to Ronnie Horner, PhD, Deputy Editor for JGIM. Dr. Horner represented the JGIM Editorial Board and served as co-editor for this issue, providing expert guidance throughout the process and strong commitment to assuring the high quality of the manuscripts. When the call for manuscripts on women's health went out, the response was overwhelming. My thanks to the researchers whose papers are included here, and to all who submitted articles and continue their work to improve women's health care. The goals of the special issue were to: (1) present the highest quality information on the health and health care delivery issues affecting women veterans, and (2) highlight research on VA organizational changes to improve access to and quality of VA women's health care. To this end, articles address topics such as: health status among women veterans, patient satisfaction among female and male users of VA services, television viewing practices and obesity among women veterans, how post-traumatic stress disorder (PTSD) screening status is associated with the use of medical and surgical care in the VA, and what physicians should know about women who serve in war. The Yano et al. paper in this special issue provides details about another important effort, the VA Office of Research and Development (ORD) initiative toward improving women's health. Last year, ORD tasked a VA Women's Health Research Planning Group to develop a comprehensive research agenda for women veterans and to position VA as a national leader in women's health research. Chaired by Dr. Yano, the Planning Group worked toward several goals that included critically appraising the VA research portfolio, identifying strategic priorities for the women's health research agenda, and fostering the conduct of research on women's health. The VA Women's Health Research Planning Group held a women's health research agenda setting conference in November 2004. The Planning Group identified key health services research priorities for women's health research. In part as a result of this work, in April 2005 a special solicitation was issued for research that will assess the chronic illness care needs of women veterans, including physical and mental health conditions and their combined impact on women veterans and their use of, and demands on, the VA health care system. Some of the research topics targeted by this solicitation include: an assessment of mental health conditions, particularly combat stress, military sexual trauma, and PTSD; access and use of health care services by women veterans, especially in regard to racial or ethnic groups, special populations (homeless women veterans), and era of service (e.g., Iraq vs Gulf war); and behavioral risk factors such as obesity, substance use, and chronic pain. Many thanks go to Dr. Yano and all members of the VA Women's Health Research Planning Group who are co-authors on the paper that summarizes the VA women's health research agenda. HSR&D is interested in research that addresses the health care needs of women veterans, including those that are unique to women or specifically related to their military service. HSR&D has a long-term commitment to an array of research that will continue to advance our understanding of the health care needs of women veterans and ensure the delivery of effective, equitable, quality health care to this important and growing segment of our veteran population.