Objective: When counseling women experiencing intimate partner violence (IPV), healthcare providers can benefit from understanding the factors contributing to a women's motivation to change her situation. We wished to examine the various factors and situations associated with turning points and change seeking in the IPV situation. Methods: We performed qualitative analysis on data from 7 focus groups and 20 individual interviews with women (61 participants) with past and=or current histories of IPV. Results: The turning points women identified fell into 5 major themes: (1) protecting others from the abuse=abuser; (2) increased severity=humiliation with abuse; (3) increased awareness of options=access to support and resources; (4) fatigue=recognition that the abuser was not going to change; and (5) partner betrayal=infidelity. Conclusions: Women experiencing IPV can identify specific factors and events constituting turning points or catalyst to change in their IPV situation. These turning points are dramatic shifts in beliefs and perceptions of themselves, their partners, and=or their situation that alter the women's willingness to tolerate the situation and motivate them to consider change. When counseling women experiencing IPV, health providers can incorporate understanding of turning points to motivate women to move forward in their process of changing their IPV situation.

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This study investigated the Alcohol Use Disorders Identification Test's (AUDIT) factor structure and psychometric properties. The factor structure was derived from a sample of 7,035 men and women primary care patients. A principal components analysis identified 2 factors in the AUDIT data and was supported in a confirmatory factor analysis (CFA). The 2 factors were Dependence/Consequences and Alcohol Consumption. The CFA also provided support for a 3-factor model whose factors (Alcohol Consumption, Alcohol Dependence, and Related Consequences) matched those proposed by the AUDIT's developers. Psychometric indexes were determined by use of the baseline and 12-month follow-up data of 301 men and women who entered a clinical trial. The results showed that the 2 factors had good reliability. Validity tests supported the interpretation of what the 2 factors measure, its implications for relationships to other variables, and the comparability of the 2- and 3-factor models.

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We sought to determine if Brief Interventions [BIs, Motivational Enhancement (ME), and Brief Advice (BA)] reduced alcohol consumption among hazardous alcohol drinking elderly (65 years or older) and whether the elderly responded similarly to younger populations. In 12 primary care offices from October 1995 to December 1997, we screened 13,438 patients of whom 2702 were elderly (180 were hazardous drinkers). Forty-five elderly enrollees were randomized to receive ME (n = 18), BA (n = 12), and Standard Care (SC, n = 12). At baseline, the elderly drank more alcohol and abstained fewer days than the younger cohort (p < 0.05). During the year, the elderly in ME, BA, and SC intervention arms increased the number of days abstained, decreased the number of drinks per day, and reduced the number of total days per month drinking. There were trends toward decreases in the alcohol consumption measures in the ME and BA treatment arms compared to SC. The elderly's response to all interventions was similar to that of the younger cohort. This study suggests that hazardous alcohol consumption in the elderly is common and that BIs reduce alcohol consumption in the elderly similar to younger populations.

OBJECTIVE:To compare patient satisfaction in women's clinics (WCs) versus traditional primary care clinics (TCs).DESIGN: Anonymous, cross-sectional mailed survey.SETTING: Eight Department of Veterans Affairs (VA) medical centers in 3 states.PATIENTS: A random sample of women stratified by site and enrollment in WC versus TC (total response rate = 61%). MEASURES:Overall satisfaction and gender-specific satisfaction as measured by the Primary Care Satisfaction Survey for Women (PCSSW). ANALYSIS:We dichotomized the satisfaction scores (excellent versus all other), and compared excellent satisfaction in WCs versus TCs using logistic regression, controlling for demographics, health status, health care use, and location.RESULTS: Women enrolled in WCs were more likely than those in TCs to report excellent overall satisfaction (odds ratio, 1.42; 95% confidence interval, 1.00 to 2.02; P = .05). Multivariate models demonstrated that receipt of care in WCs was a significant positive predictor for all 5 satisfaction domains (i.e., getting care, privacy and comfort, communication, complete care, and follow-up care) with the gender-specific satisfaction instrument (PCSSW). CONCLUSIONS:This study is the first to consistently show higher satisfaction in WCs versus TCs despite age and race differences and comparable health status. Since these WCs show better quality in terms of satisfaction, other quality indicators should be evaluated. If WCs reduce fragmentation and improve health care delivery, the model will be applicable in VA and non-VA outpatient settings. 7 These programs vary in their organization, ranging from comprehensive gender-specific primary care delivered by women's health specialists to strictly reproductive care for women. 8 Despite the increasing numbers, few data demonstrate whether specialized women's health centers improve the quality of primary care for women. Two recent studies compared satisfaction, 1 aspect of quality, in specialized women's clinics (WCs) versus traditional primary care clinics (TCs) 1,9 and found similar ratings of overall satisfaction between patients in the 2 settings. While 1 study did find differences along items specific to patientphysician communication, 1 the findings did not impact overall outcomes. However, these studies were limited to a small number of academic practices in a single city serving primarily higher-income women.In contrast, medical centers within the Department of Veterans Affairs (VA) offer the opportunity to compare WCs and TCs in multiple locations with a less affluent population. Since 1992, when the VA began encouraging the development of specialized women's health programs to address disparities for women veterans, 10 a majority (62%) of VA sites report a women's health program or center. 11 We initiated this study to evaluate patient satisfaction among women veterans in WCs versus TCs. On the basis of the concept that comprehensive centers or single systems with multispecialty services 12 provide higher satisfaction, we hypothesized that patient satisf...

An overall minority of providers, most notably in FM and IM, use the Gail model to assess, and chemoprevention to decrease, breast cancer risk. Until providers are more consistent in their use of the Gail model (or other breast cancer risk calculator) and chemoprevention, opportunities to intervene in women at increased risk will likely continue to be missed.