3070 — Facilitators and Barriers to Health Care among Male and Female Veterans with PTSD

Ouimette P (Syracuse VAMC), Tirone V (Syracuse VAMC), Kimerling R (Palo Alto VAMC), Vogt D (Boston VAMC), Laffaye C (Palo Alto VAMC), Greenbaum M (Palo Alto VAMC), Fitt J (Palo Alto VAMC), Rosen C (Palo Alto VAMC)

Objectives:
An important concern for VA has been the treatment of Post-traumatic Stress Disorder (PTSD) among male and female veterans. Information regarding healthcare perceptions of veterans with PTSD using VHA care is important for service planning and provision. This study examined a model of facilitators and barriers to healthcare use and explored gender differences in these factors among veterans entering a new episode of PTSD care.

Methods:
All veterans starting a new episode of VA PTSD care between March 2006 and December 2007 were identified using VA databases. A new episode was defined as having no PTSD diagnosis and PTSD treatment for two years prior to the current index treatment. A random sample was mailed a survey within 2-3 months following their treatment episode. Survey items asked about demographic background, health status, and barriers to health care. A total of 500 veterans completed the survey (30% of those contacted). Participants received $10 for completing the packet. The survey assessed three stigma-related factors (concerns about negative evaluations, not “fitting into” VA care, and discomfort with help-seeking) and two institutional factors (staff skill and sensitivity, and ease of use/availability of services).

Results:
About half of the sample was male (53%), married (46%), and the majority was white (62%). Women were slightly younger than men (38 vs. 43). The average score was in the “slightly” to “moderately” range on the two measures of stigma, concerns about negative evaluations and discomfort with help-seeking, and in the “not at all” to “slightly” range on not fitting into VA care, and on both institutional measures. Men with PTSD reported more concerns about negative evaluations than women with PTSD. A trend emerged for women with PTSD to endorse not fitting into VA care to a greater degree than men with PTSD. No other gender effects were observed.

Implications:
Veterans with PTSD report more concerns about stigma than about institutional barriers. Gender was associated with specific barriers. Given that perceived barriers may affect healthcare use, further work should elucidate on these barriers and their impact on health care use.

Impacts:
Results suggest potential targets for improving care for male and female veterans with PTSD.