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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1056 — Factors Contributing to Women Veterans’ Decisions to Discontinue VHA Health Care

Hamilton AB, VA Greater Los Angeles Healthcare System + UCLA; Frayne S, HSR&D COE-Palo Alto; Bean-Mayberry B, and Yano EM, VA Greater Los Angeles Healthcare System; Friedman SA, HSR&D COE-Sepulveda; Washington DL, VA Greater Los Angeles Healthcare System + UCLA;

Objectives:
Increasing women Veterans’ access to VHA services is among VA’s 21st century transformational initiatives. While women’s enrollment rates have climbed, preliminary evidence suggests that discontinuation of VHA use is not uncommon. Using data from the National Survey of Women Veterans (NSWV), we identified factors contributing to women deciding to discontinue VHA health care.

Methods:
In 2008-09, we conducted a telephone survey among a national, population-based sample of women Veterans (n = 3,611; 86% response rate), oversampling VHA users and OEF/OIF Veterans. Survey items included settings for and influences on healthcare use. Current users were defined as those whose last VHA visit was within the prior 12 months; former users were those who self-defined as such and/or whose last VHA visit was more than 12 months ago.

Results:
817 respondents were former users at the time of the survey. Women’s main reason for no longer using VHA was that it was too far from their home, with almost one-third (30%) endorsing this reason. Almost one quarter (22%) indicated that having non-VA health insurance was their reason for discontinuing VHA use. Nine percent indicated that quality of care outside VA is higher, 8% indicated a prior bad experience with VA, and 6% found it difficult to get an appointment with VA when needed. Some significant differences by service era emerged, with post-Vietnam Veterans more likely to endorse a prior bad experience with VA (p < .0001) and difficulty with obtaining an appointment (p < .01).

Implications:
A substantial proportion of women Veterans decided to discontinue using VHA care, typically due to location and availability of other insurance, though also due to negative experiences.

Impacts:
Current efforts to retain women in VA care must address service adequacy and convenience, as well as negative perceptions of quality of care and negative experiences within VA. Recent policies to strengthen women Veterans’ healthcare at community-based outpatient clinics may help to ameliorate the problem of distance to VA healthcare. A next step in addressing attrition from VHA could be to identify modifiable organization-level predictors of attrition as a target for future action.


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