VA grants fund telehealth, training to improve care for women veterans

Dr. Kim Ho, pharmacy director at the VA Hospital in El Paso, has received a grant to provide pharmacy services via teleconference with women veterans in rural areas. (Mark Lambie | El Paso Times)

Dr. Kim Ho, pharmacy director at the VA Hospital in El Paso, has received a grant to provide pharmacy services via teleconference with women veterans in rural areas. (Mark Lambie | El Paso Times)

The Veterans Affairs medical center in El Paso, Texas, hosted a clinic for women patients to learn about managing cholesterol last year, but pharmacy chief Tuyen Kim Ho ended up disappointed.

Few women showed up.

When Ho learned why the women didn’t come — the hospital was too far, they had to work or couldn’t arrange babysitters — she began searching for a workaround.

Her solution now has financial backing: a $151,500 grant from the Department of Veterans Affairs in Washington will allow Ho to hire another pharmacist this March to work with rural women patients.

“We want to make the distance not a problem anymore,” Ho said. “We can extend our care for patients in rural areas.”

The grant was one of 33 worth $2 million recently announced by the VA to help its health care system improve services to women veterans.  The fastest growing subset of veterans, women are still less likely to enroll in VA health care than men.

Nonetheless, the number of women veterans using the VA increased 83 percent to 292,000 women between 2000 and 2009, according to the 2012 report “Strategies for Serving Our Women Veterans.”

Dr. Kim Ho, pharmacy director at the VA Hospital in El Paso, demonstrates how rural women veterans can receive pharmacy services via teleconferences. (Mark Lambie | El Paso Times)

Dr. Kim Ho, pharmacy director at the VA Hospital in El Paso, demonstrates how rural women veterans can receive pharmacy services via teleconferences. (Mark Lambie | El Paso Times)

‘It’s…like Skyping.’

The new grants fall within three categories: Some help VA hospitals improve their emergency care for women, some focus on training VA staff on female-specific issues and others help VA hospitals offer telehealth programs to women in rural areas.

The El Paso grant is in the third category. The hospital , which cares for patients from a wide swath of southwest Texas and southeast New Mexico, has more than 2,000 rural women veterans.

The money will allow Ho to hire a new pharmacist and train him or her in issues specific to women, such as which medicines are not good for women in child-bearing years or those who are pregnant or nursing.

Like Ho herself, the pharmacist will need a doctorate so he or she can make changes in dosages or other tweaks without sending the patient back to a doctor.

The pharmacist will remain in El Paso, but meet, via teleconferencing, women patients at VA clinics closer to their homes. “It’s almost like Skyping,” Ho said.

Using results of lab tests or blood pressure checks at the clinic, the pharmacist will be able to discuss medicine issues with the patient.

Welcoming women

 Gina Painter, director of the VA women’s clinic in Salt Lake City, said veterans’ first VA experience is often in the emergency room. A grant will allow the facility to create a room more welcoming to women veterans. (Djamila Grossman  |  The Salt Lake Tribune)


Gina Painter, director of the VA women’s clinic in Salt Lake City, said veterans’ first VA experience is often in the emergency room. A grant will allow the facility to create a room more welcoming to women veterans. (Djamila Grossman | The Salt Lake Tribune)

At the Salt Lake City VA hospital, a much smaller grant — $8,259 — will be used to transform one of the emergency rooms into one that is more welcoming for women veterans.

“We hope to create an area that’s more calm and away from the rest of the hubbub,” said Anne Beck, the emergency department nurse manager at the George E. Wahlen Veterans Affairs Medical Center.

The hospital has 14 emergency room beds, six of them in a large room with beds separated by curtains and the others in private rooms.

The redecorated and refurnished room will be used for all patients, but perhaps most welcomed by women who bring children or need gynecological examinations, Beck said.

The grant will allow purchase of an obstetrical-gynecological gurney that will be more comfortable than the usual examination tables, she said.

Gina Painter, director of the VA women’s clinic in Salt Lake, said veterans’ first experience at the VA is often in the emergency room.

  Darlene Bledsoe, an Army veteran, gets an EKG reading during a visit last year by nurse Nancy Dice, as they talk with Gina Painter, who manages the clinic dedicated to women veterans at the VA Medical Center in Salt Lake City. (Djamila Grossman  |  The Salt Lake Tribune)

Darlene Bledsoe, an Army veteran, gets an EKG reading during a visit last year by nurse Nancy Dice, as they talk with Gina Painter, who manages the clinic dedicated to women veterans at the VA Medical Center in Salt Lake City. (Djamila Grossman | The Salt Lake Tribune)

It can be particularly traumatic for a female veteran who has suffered from military sexual assault to wait or receive care while surrounded by men, she said.

“The ER can be a frustrating, scary place in general, but when you’re a minority in the system, it can be even worse,” said Painter.

The room will be repainted and decorated to suit womens’ tastes, and will have a recliner for spouses or children, she said.

The Greater Los Angeles VA Medical System is getting a similar grant, for $7,198, which will allow it to create a “female only” space, said Callie Wight, women veterans program manager for the system.

That hospital also is getting a $43,800 grant to provide “mini-residencies” for its emergency room doctors, nurses, technicians and clerks. The training will better equip them to be sensitive to women’s issues such as the effects of military sexual trauma, Wight said.

“If you see men most of the time and hardly ever see a female patient, it really is a good idea to have that extra training,” she said.

Dr. Erin Krebs, left, women's health director at the Minneapolis VA hospital, and women's health care coordinator Katie Westanmo discuss gift baskets for new mothers donated by the American Legion. The hospital was recently awarded $217,000 in grants to improve health care for women veterans.  (Glen Stubbe | Star Tribune)

Dr. Erin Krebs, women’s health director at the Minneapolis VA hospital, and women,s health care coordinator Katie Westanmo discuss gift baskets for new mothers donated by the American Legion. The hospital was recently awarded $217,000 in grants to improve health care for women veterans. (Glen Stubbe | Star Tribune)

Targeting rural, pregnant veterans 

The Minneapolis VA Health Care System is getting $217,000 in grants, including one to develop a pharmacy telehealth program like the one beginning in El Paso and another to refresh the training of primary care nurses in rural VA clinics.

Minneapolis’ third grant is actually a share of a $200,000 grant to the Greater Los Angeles VA to continue testing a program that has maternity nurse coordinators calling veterans in rural areas during their pregnancies.

Only a few VA hospitals have gynecologists, so most pregnant veterans get their care outside the VA, but paid by the VA.

The program being tested is a way to make sure pregnant veterans get the care they need and also know of VA benefits, said Dr. Erin Krebs, the medical director for the Minneapolis VA.

The grant is for one year, but “this is the kind of thing that could be rolled out at relatively low expense using existing staff,” Krebs said.

Besides the Minneapolis hospital, VAs in San Diego and Loma Linda, Calif., are trying out the pilot project this year.

  Dr. Erin Krebs, left,  and Linda Van Egeren, women's clinic psychologist at the Minneapolis VA hospital, discuss a new telehealth program. (Glen Stubbe | Star Tribune)

Dr. Erin Krebs, left, and Linda Van Egeren, women’s clinic psychologist at the Minneapolis VA hospital, discuss a new telehealth program. (Glen Stubbe | Star Tribune)

Under one of the grants in Minneapolis, nurses from VA clinics as far away as North Dakota and South Dakota will spend nearly three days in Minneapolis getting a refresher course in taking care of women, Krebs said.

“If you’ve been a long-time VA nurse, you may not have seen very many women over the years,” she said. “And that’s changing very rapidly.  Now women are not rare around the VA anymore.”

Stacey Hunt, a retired staff sergeant in the Minnesota National Guard, told the Star Tribune that while she sees VA women’s health care improving, “They have a long ways to go.”

Hunt has used the Minneapolis VA after filing a disability claim for a broken ankle she sustained while deployed on active duty, the Minneapolis newspaper said.

“They are making it more comfortable for women, but it is still taking them a long time to make the right appointments for me because maybe my injury isn’t so obvious to the eye. I get the runaround,” Hunt told the Star Tribune. “We just kind of get pushed to the back sometimes.”

Krebs said that from her vantage, it’s an exciting time because women’s health is a now a priority.

Women today comprise 15 percent of the active duty military and nearly 18 percent of the National Guard and Reserve forces. The VA estimates that by 2020, women veterans will comprise 10 percent of the veteran population.

“There is a ton of activity in this area right now,”Krebs said. “We’re facing a high degree of scrutiny.  The public and politicians expect us to step up to the plate and I think that is what is happening.”

kmoulton@sltrib.com

 

 

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