摘要 :
The United States has been at war longer than any time in its history. While thousands have been wounded in these conflicts, advances in battlefield medicine mean many of our troops survive catastrophic wounds. The nature of many ...
展开
The United States has been at war longer than any time in its history. While thousands have been wounded in these conflicts, advances in battlefield medicine mean many of our troops survive catastrophic wounds. The nature of many of their wounds, however, means some require long-term caregiving support. The Elizabeth Dole Foundation commissioned RAND Corp to assess the needs of military caregivers, scan the services available to them, and identify how their needs are -- and are not -- being met. This report reviews existing research on the needs of caregivers in general, and assesses how lessons learned can be applied to military caregivers. We also present information gleaned from military caregivers themselves and from policymakers and program officials who either directly support, or advocate on behalf of, military caregivers. We provide a snapshot of the number and characteristics of military caregivers, the roles they serve, the physical and emotional impact caregiving has on their lives, and the resources available to them. Military caregivers tend to be younger women with dependent-age children, dealing with a different set of patient variables than the general caregiver population. Along with typical caregiver responsibilities, military caregivers also act as case managers navigating multiple health systems, advocates for new treatment, and financial and legal representatives. Many are also raising children and holding jobs outside the home. Studies indicate that caregivers in general suffer from physical strain and overall worse health and tend to put their own concerns behind those of the individuals for whom they are caring. Military caregivers suffer disproportionately from mental health problems and emotional distress. Many government programs are still in their infancy, and community resources are scattered and uncoordinated. Difficulties are presented by differing eligibility criteria, lack of access, and the way caregivers' needs change over time.
收起
摘要 :
Since October 2001, approximately 1.7 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq). The pace of the deployments in these current conflicts is un...
展开
Since October 2001, approximately 1.7 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq). The pace of the deployments in these current conflicts is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006). Not only are a higher proportion of the armed forces being deployed, but deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006). At the same time, episodes of intense combat notwithstanding, these operations have employed smaller forces and have produced casualty rates of killed or wounded that are historically lower than in earlier prolonged wars, such as Vietnam and Korea. Advances in both medical technology and body armor mean that more servicemembers are surviving experiences that would have led to death in prior wars (Regan, 2004; Warden, 2006). However, casualties of a different kind have emerged in large numbers--invisible wounds, such as post traumatic stress disorder. As with safeguarding physical health, safeguarding mental health is an integral component of the United States' national responsibilities to recruit, prepare, and sustain a military force and to address service-connected injuries and disabilities. But safeguarding mental health is also critical for compensating and honoring those who have served our nation.
收起
摘要 :
Since October 2001, approximately 1.64 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq). The pace of the deployments in these current conflicts is u...
展开
Since October 2001, approximately 1.64 million U.S. troops have deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq). The pace of the deployments in these current conflicts is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006). Not only is a higher proportion of the armed forces being deployed, but deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006). At the same time, episodes of intense combat notwithstanding, these conflicts have produced casualty rates of killed or wounded that are historically lower than in earlier prolonged con icts, such as Vietnam and Korea. Advances in both medical technology and body armor mean that more servicemembers are surviving experiences that would have led to death in prior wars (Regan, 2004; Warden, 2006). However, casualties of a different kind- invisible wounds, such as mental health conditions and cognitive impairments resulting from deployment experiences- are just beginning to emerge. Recent reports and increasing media attention have prompted intense scrutiny and examination of these injuries.
收起
摘要 :
My testimony will briefly discuss several recommendations for addressing the psychological and cognitive injuries among servicemembers returning from deployments to Operations Enduring Freedom and Iraqi Freedom. Dr. Jaycox shared ...
展开
My testimony will briefly discuss several recommendations for addressing the psychological and cognitive injuries among servicemembers returning from deployments to Operations Enduring Freedom and Iraqi Freedom. Dr. Jaycox shared with you our findings about the prevalence of post-traumatic stress disorder and depression, as well as the incidence of traumatic brain injury among servicemembers returning from Operations Enduring Freedom and Iraqi Freedom; the costs to society associated with these conditions and of providing care to those afflicted with these conditions, and the gaps in the care systems designed to treat these conditions among our nation's servicemembers and veterans. Together, Dr. Jaycox and I co-directed more than 30 researchers at RAND in the completion of this study and our testimony is drawn from the same body of work. The purpose of these recommendations is to close the gaps in access and quality for our nation's veterans that Dr. Jaycox briefly described in her testimony.
收起
摘要 :
Over the past three years, state and local health departments throughout the United States have undertaken a variety of activities and initiatives to improve their level of preparedness for bioterrorism and other public health eme...
展开
Over the past three years, state and local health departments throughout the United States have undertaken a variety of activities and initiatives to improve their level of preparedness for bioterrorism and other public health emergencies. Under a contract with the Department of Health and Human Services (DHHS), RAND was asked to develop a repository of practices for public health emergency and bioterrorism preparedness at the state and local levels that can serve as exemplars of preparedness for responding to bioterrorism and other public health emergencies. The selection of exemplary practices is one of several tasks in RAND's work for DHHS. This report describes RAND's approach and methods for identifying and evaluating practices and describes the individual practices nominated as exemplary. The selection of exemplary practices involved several steps, including: establishing definitions of key terms; determining initial selection criteria; collecting preliminary data on public health practices; identifying initial candidate practices; collecting additional data on a set of identified candidate practices; and selecting final exemplary practices.
收起
摘要 :
The Military Health System (MRS) has approximately 8.7 million eligible beneficiaries. These beneficiaries include active duty military personnel and their family members, retired military personnel and their family members, and s...
展开
The Military Health System (MRS) has approximately 8.7 million eligible beneficiaries. These beneficiaries include active duty military personnel and their family members, retired military personnel and their family members, and surviving family members of deceased military personnel. In 2001, the Department of Defense (DoD) spent just over $2 billion on pharmacy benefits. Much like the private health care sector, the MRS has experienced a rapid growth in pharmaceutical expenditures, which have increased an average of 17 percent a year over the past six years. Both the DoD and the U.S. Congress have identified the MRS pharmacy benefit as an area for reform. To this end, Section 701 of the National Defense Authorization Act for Fiscal Year 2000 requires the Secretary of Defense to establish an effective, efficient, and integrated pharmacy benefits program. According to the legislation, titled the Pharmacy Benefits Redesign Program, The pharmacy benefits program shall include a uniform formulary of pharmaceutical agents which shall assure the availability of pharmaceutical agents in the complete range of therapeutic classes. The Act further specifies that The uniform formulary will be applicable to all prescribers within the facilities of the uniformed services (i.e., military treatment facilities MTFs) and the TRICARE program. The pharmaceutical agents on the formulary will be available through the MTFs and retail pharmacies designated or eligible under the TRICARE program, as well as the National Mail Order Pharmacy program.
收起
