1035. Comprehensive Care for Women Veterans: Indicators of Dual Use of VA and Non-VA Providers
Bevanne A Bean-Mayberry, MD, MHS, VA CHERP, VA Pittsburgh Healthcare System, CH Chang, University of Pittsburgh, M McNeil,
University of Pittsburgh and VA CHERP, VA Pittsburgh Healthcare System, P Hayes,
VA CHERP, VA Pittsburgh Healthcare System, SH Scholle,
National Committee for Quality Assurance, Washington, DC and University of Pittsburgh
Objectives: To identify the health care experience factors (e.g., provider gender, provider covers routine gynecological care, overall satisfaction, and use of a VA womenís clinic) that influence dual use of non-VA regular providers among women veterans who have a regular VA provider.
Methods: An anonymous survey was mailed to a random sample of women veterans from VISN4 to evaluate satisfaction with VA primary care (RR 61%, N=1321). A secondary analysis on dual use of providers was performed with the subgroup of women (N=1051) who identified their VA regular provider. Multiple logistic regression analyses were performed to determine the effect of each health care experience factor on use of a non-VA regular provider with adjustment for patient demographics, health status, service connection, and clustering by site.
Results: Provision of routine gynecological care by VA provider (OR 0.37, 95%CI 0.22, 0.60) and use of VA womenís clinics (OR 0.56, 95%CI 0.35, 0.90) were significantly associated with a lower likelihood of dual use. However, dissatisfaction (OR 1.88, 95%CI 1.04,3.41) and income (OR 1.89, 95%CI 1.32, 2.71) were the characteristics associated with an increased likelihood of dual use.
Conclusions: Women veteranís use of VA and non-VA regular providers is not associated with provider gender but is influenced by modifiable factors such as satisfaction or a broader scope of services from the provider or clinic setting.
Impact: VA primary care should promote routine gynecological care within primary care or linked with VA womenís clinics to enhance coordination and comprehensiveness and, thus, reduce fragmentation of care.