Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4102 — Gender Differences in Healthcare Utilization among OEF/OIF/OND Veterans With Musculoskeletal Diagnoses

Lead/Presenter: Harini Bathulapalli, COIN - West Haven
All Authors: Bathulapalli H (VA West Haven) Driscoll MA (VA West Haven) Buta E (VA West Haven) Ramsey C (VA West Haven) Bastian LA (VA West Haven) Brandt C (VA West Haven)

Objectives:
A local investigation of Veterans with pain revealed that women evidenced more primary care, and physical therapy visits relative to men in FY2003; no gender differences in use of mental health or specialty pain clinics were observed. Recent data from OEF/OIF/OND Veterans reveals that among those with musculoskeletal diagnoses (MSD), men and women were equally likely to elect use of specialty pain services; no examination of differences in the frequency of use was offered. Accordingly, gender differences in utilization of primary care, pain clinic, physical therapy and mental health services are examined in a national cohort of OEF/OIF/OND Veterans with MSD.

Methods:
Administrative data from the Women Veterans Cohort Study, which includes all Veterans who separated from service after September 12, 2001 and enrolled in VA healthcare, were extracted from CDW. 295,179 Veterans (88.2% men) with an ICD-9 MSD prior to FY2011 were retained from a sample of 1,063,973. Negative binomial regression examines gender differences in utilization of primary care, pain clinic, physical therapy and mental health in the year following MSD controlling for age, race, education, marital status, and mental health comorbidities.

Results:
The sample was 31.5(SD = 9.7) years old and averaged 3.1(SD = 4.6) primary care, 0.1(SD = 0.7) specialty pain, 1.0(SD = 4.3) physical therapy and 5.5(SD = 17.4) mental health visits. Relative to men, women Veterans with MSD who served in support of OEF/OIF/OND reported 30% more primary care visits (95% CI 28 to 32%; p < .001), 14% more specialty pain visits (95% CI 3 to 27%; p < .05), and 14% more physical therapy visits (95% CI 11 to 19%; p < .001). By contrast, men reported 12% more mental health visits (95% CI 9 to 15%; p < .001)

Implications:
With the exception of mental health, women Veterans with MSD who served in support of OEF/OIF/OND have higher utilization than men in the year following incident diagnosis. Differences between this investigation and prior findings may reflect cohort variations and selection criteria which did not capture pain chronicity.

Impacts:
Women are using VA care at rates not previously observed. Findings suggest the potential need for VA to augment existing services to keep pace with the demand for care among women, especially as this cohort ages.