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2019 HSR&D/QUERI National Conference Abstract

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1174 — Availability of Comprehensive Primary Care for Women Veterans and Impacts on Ratings of Patient-Provider Communication

Lead/Presenter: Danielle Rose,  COIN - Los Angeles
All Authors: Rose DE (Center for Study of Healthcare Innovation, Implementation & Policy), Oishi S Center for Study of Healthcare Innovation, Implementation & Policy Canelo C Center for Study of Healthcare Innovation, Implementation & Policy Yano, EM Center for Study of Healthcare Innovation, Implementation & Policy, UCLA Fielding School of Public Health, Department of Health Policy & Management, Los Angeles, CA

Objectives:
VA has prioritized the availability of comprehensive primary care (PC) to women Veterans (a numerical minority 8-10%), nonetheless, offering such care remains challenging. Effective patient-provider communication is associated with improved patient satisfaction, shared decision-making, and patient self-management. We explore if the availability of comprehensive primary care is associated with improved patient-provider communication.

Methods:
We surveyed all primary care directors at clinics serving 300 or more women Veterans in FY 2016 (n = 326), then linked data with women Veterans' responses about healthcare experiences. We asked about availability of women's health services (e.g., menstrual disorders, menopausal, contraceptive counseling) and time available (all weekday hours v. some/not available) at their site. VA's Survey of Healthcare Experiences of Patients utilizes CAHPS-PCMH ratings of patient-provider communication. We conducted multi-level ordinal logistic regression predicting patient ratings controlling for clustering of respondents, survey weights for sampling design and non-response, respondent demographics, and facility- and area-level characteristics.

Results:
The response rate for the organizational survey was 39% (n = 126), The final sample included 3,816 women Veterans receiving primary care at 122 sites (4 primary care leaders skipped questions). Many sites (57%) reported that all services were available all weekday hours. Overall, women Veterans reported their provider always explained things (73%); listened carefully (70%); gave information about their condition(s) (67%); showed respect (76%); and spent enough time with them (68%). In adjusted analyses, Women Veterans receiving care at sites with greater number of women's health services available all weekday hours were more likely to report that providers always: 1) explained things in a way that was easy to understand (OR: 1.06, 95%CI: 1.02-1.10); 2) listened carefully (OR: 1.05, 95%CI: 1.00-1.10); 2) gave easy to understand information (OR: 1.06, 95%CI: 1.01-1.11); 4) showed respect (OR: 1.06, 95%CI: 1.01-1.11) and 5) spent enough time (OR: 1.05, 95%CI: 1.01-1.10).

Implications:
Availability of comprehensive care was associated with improvements in Women Veterans' care experiences.

Impacts:
Comprehensive care cannot be offered on a part-time basis, as having fewer services available full-time was associated with a decrement in ratings of patient-provider communication.