Of primary concern are the 7% who are not enrolled in the VHA but qualify for coverage, the 10% living in poverty, the 7% without any health coverage, and the 0.2% who suffer from compensable PTSD and have undiagnosed hypertension. Outreach programs will be developed to enhance access to blood pressure screening and treatment, in collaboration with MEDVAMC, Texas Department of Health and Services Commission (TDHSC), and facilities providing services to the homeless population.
The interventions required are collaboration, outreach, screening, and referral and follow-up (MDH, 2001). A priori, coalition building would not be necessary since most veterans would qualify for coverage by the VHA or a public insurance plan. Therefore, the goal of this intervention would be to inform women veterans in the Houston area about the health risks associated with hypertension, where to get screened and how often, and how to gain access to treatment when necessary. Informational brochures will be placed at the MEDVAMC medical center and satellite clinics, VA regional office, the local offices of the TDHSC, and facilities providing services to the homeless.
A toll-free phone number will be provided that would allow women veterans to discuss their screening and treatment access problems with a liaison, who could then direct the veteran to a relevant provider. The relevant providers would include the Women Veterans Program Manager at the VHA and the local TDHSC office. Program progress would be evaluated every six months initially, to facilitate making necessary adjustments rapidly to ensure program efficacy. Additional information on hypertension and preventive strategies (lifestyle changes) would also be mailed to callers free of charge when requested.
Patient data would be collected bi-annually for the first year of program implementation and then annually for subsequent years. VHA, TDHSC, and 'other' hypertension program screening and referral enrollment statistics will be collected and tracked overtime, as well as overall figures for the number of hypertension screenings and hypertension treatment referrals conducted. Tracking of veteran status through TDHSC will be the most problematic and every effort will be made to convince providers to comply with reporting needs. The information collected will include the number of blood pressure screenings and hypertension treatment referrals. The number of veterans who contact the hypertension program using the toll-free number will be tracked, as well as the outcome of follow-up contacts made by program staff.
Public health interventions can be a democratizing force, if it addresses health disparities along racial and socioeconomic lines. Although the magnitude of the changes can be small and incremental, the individual and overall effect can be very gratifying to witness. Women veterans in particular are returning from war zones with service-connected disabilities that increase their risk for developing hypertension, and thus CVD. Given their service to our country and their higher than average minority status, it is especially gratifying to improve the health of this demographic.
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Table 1: Women's Heart Foundation Recommended Guidelines for Blood Pressure Screening (2002).
Figure 1: Community Health Diagnosis for Women Veterans in the Houston Area