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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3012 — Availability of General and Specialty Women’s Health Services at CBOCs: VHA Survey of Women Veterans Health Programs and Practices, 2007

Canelo IA (Sepulveda COE), Rose DE (Sepulveda COE), Bean-Mayberry B (Sepulveda COE), Washington DL (Sepulveda COE), Yano EM (Sepulveda COE)

Objectives:
While improving women veterans’ access to care is a top priority for the VA, little is known about differences in women’s health services available at Community Based Outpatient Clinics (CBOCs) compared to VA Medical Centers (VAMCs). Here we describe differences in women veterans’ access to general and specialty health services at CBOCs vs. VA Medical Centers.

Methods:
We analyzed data from the 2007 VHA Survey of Women Veterans Health Programs and Practices which queried senior women’s health clinicians at VAMCs and CBOCs in 2007. Our analytic sample includes 195 sites (86% response rate). We queried clinicians about the availability of 22 women’s general and specialty health services. Clinicians reported: offering services at their VA; services only available at another VA; service available through contract or fee-basis providers, other arrangements, or services not available. We performed chi-square tests to compare care arrangements at VAMCs and CBOCs.

Results:
For 12 of 22 services, we found statistically significant differences in service availability between VAMCs and CBOCs. For example, a majority of CBOCs reported that mammograms were available at another VA (62%), while most VAMCs indicated mammograms were available through fee-basis or contract providers (69%, p < 0.05). Similarly, most CBOCs indicated diagnostic mammograms were available at other VAs (64%) , while most VAMCs indicated this service was available through contract or fee-basis providers (75%, p < 0.05). For diagnosis of menstrual disorders, 77% of CBOCs indicated that care was available at another VA, while 93% of VAMCs indicated services were available onsite (p < 0.001). For sexual trauma counseling and treatment, 98% of VAMCs reported onsite availability of this services 87% of CBOCs reported these services were available onsite (p < 0.01).

Implications:
While care for patients with sexual trauma is widely available across CBOCs and VAMCs, menstrual care and mammography services are predominantly referred to other VA sites from CBOCs. In addition, most VAMCs also contract out for mammography care, indicating additional patient visits plus outside costs for routine gender-specific services for women veterans.

Impacts:
Gender-specific primary care needs innovative solutions in systems redesign and coordination to streamline women veterans’ access to care and to assess VA costs for routine gender-specific care contract/fee basis in our current setting of increasing numbers of women VA users.


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