DAV Magazine March/April 2018 : Page 22

make minimally invasive surgeries more difficult. After reviewing the findings from their initial report published last year, the research team wants to conduct a patient-centered study to learn more about the causes of the potential disparity—and how to address it. “We are interviewing VA providers, reviewing charts to see if there’s other factors,” explained Callegari. “We need to do a better job of characterizing the problem.” The 2014 DAV report Women Veterans: The Long Journey Home found that only one-third of VA medical centers had gynecologists on staff. Katon said the number is increasing, but when it From left: VA researchers Drs. Jodie Katon and Lisa Callegari, is not feasible to provide gynecological services along with VA Office of Health Equity Chief Officer Dr. Uche on site, veterans are referred to outside care. Uchendu, traveled to Washington, D.C., for a VA Health Services “Whenever possible, facilities with on-site Research and Development Conference last year, where Callegari gynecology surgery should be able to offer presented research on trends of women veterans undergoing minimally invasive procedures so all women hysterectomies. have that opportunity,” said Katon. “We want hysterectomy is less invasive but can only be performed to build up and improve gynecology services across in certain situations. More recently, a procedure with the board.” smaller incisions—laparoscopic hysterectomy—has Both Katon and Callegari stressed that training made less invasive hysterectomies available in more gynecologists and providing the equipment to enable situations. Like vaginal hysterectomies, the laparoscopic them to perform more minimally invasive procedures hysterectomy tends to cause less pain and offers a faster are necessary for addressing the disparity. recovery time. The researchers have begun presenting their For physicians with specialized training, along with findings at medical conferences. They work closely the required equipment, laparoscopic hysterectomies with the VA Office of Health Equity and Women’s can be conducted using a thin lighted viewing tube and Health Services and have shared their research a high-resolution camera, allowing physicians to take throughout the rest of the VA. out the uterus through small incisions. “It is a huge advantage; we have people making Callegari said that whenever possible, the least-large policy decisions working with us. We can report invasive technique should be used. back recommendations, and they have the potential to “There will be exceptions, as not all women can safely implement these changes,” said Katon. have a minimally invasive hysterectomy, but we want to “These findings are important to DAV as we continue minimize that to the extent possible,” she stressed. to work closely with the VA to ensure parity in services The researchers used VA medical data from across for all veterans regardless of gender,” said National the country to examine the trends of women veterans Commander Delphine Metcalf-Foster. “It’s great to see and hysterectomies. Their comparison showed that the VA identify disparities in care and immediately the VA’s rates aligned with civilian women nationwide, work to address them, and I think this highlights the but also showed that African-American veterans were need for even more research surrounding women and approximately 40 percent less likely to have a minimally minority veterans to correct such issues.” invasive hysterectomy compared to Caucasian veterans. “At the VA, we can look at this and design national The research also showed that women of color are interventions to reduce disparities,” said Callegari. more likely to have large fibroids, masses on the uterus, “It’s an exciting opportunity to improve health care which is a common cause of hysterectomies and may for women throughout the country.” ■ 22 DAV MAGAZINE MARCH | APRIL 2018

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