120: Engaging Women Veterans In Cardiovascular Disease Risk Reduction: Provider Perceptions of Patient Barriers to Risk Management

Moreau JL, Bean-Mayberry BA, Dyer KE, Finley E, Chanfreau CC, Schweizer CA, Brunner JW, Moin T, Hamilton AB, Farmer Coste MM. 120: Engaging Women Veterans In Cardiovascular Disease Risk Reduction: Provider Perceptions of Patient Barriers to Risk Management. [Abstract]. Clinical Cardiology. 2019 Nov 8; 42(Suppl 2):S36-S50.

Background/Synopsis: Gender disparities persist both nationally and within the Veterans Affairs (VA) healthcare system for many cardiovascular (CV) risk factors, such as lipid control, blood pressure control and intermediate diabetes outcomes. Innovative approaches are needed to target and promote CV risk identification and reduction in women Veterans. Objective/Purpose: To explore clinic staff perceptions of patient-level barriers to CV risk management among women Veterans in VA prior to the implementation of a multi-site primary care-based CV Toolkit study aimed at maximizing women Veterans' engagement in care. Methods: We conducted semi-structured interviews with key stakeholders (primary care providers, medical directors, nurses, health coaches and other staff directly involved in care delivery) at three VA women's clinics. Transcripts were summarized and matrix analysis techniques were used to identify themes across interviews. Results: Participants (n = 24) described a wide variety of barriers that women Veterans face when managing CV risks and making lifestyle changes. The most prominent barriers included time constraints (impeded by work, school, or caregiving), mental or other physical health issues (especially pain), finances and food/housing insecurity, lack of urgency and low readiness to change, and lack of social support. Barriers to attending patient group sessions for making behavioral health changes included: distance to VA, transportation, conflicts with group schedules, and individual discomfort with a group format. Clinical staff highlighted barriers more specific to women, such as caregiving demands and family issues that translated into lack of time or support at home. Conclusions: Stakeholders identified several patient barriers to CV risk management and lifestyle changes including socio-economic, health, and individual barriers that clinic staff are likely to encounter. Patient barriers to engagement in CV risk management underscore the need for clinic staff to consider novel approaches to best reach women Veterans. Our findings suggest barrier reduction strategies may be critical in promoting women Veterans' heart health. Innovations that assist with overcoming barriers, such as offering health coaching via phone, which we are currently piloting, may move patients toward lifestyle changes and treatment goals that optimize care and reduce CV risks.