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2019 HSR&D/QUERI National Conference Abstract

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4134 — The Influence of Patient-Provider Relationships on Women Veterans' Attrition from VA Healthcare

Lead/Presenter: Karen Dyer,  COIN - Los Angeles
All Authors: Dyer KE (Center for the Study of Healthcare Innovation, Implementation & Policy [CSHIIP], VA Greater Los Angeles Healthcare System, Los Angeles, CA), Moreau JL (Center for the Study of Healthcare Innovation, Implementation & Policy [CSHIIP], VA Greater Los Angeles Healthcare System, Los Angeles, CA), Chrystal JG (Center for the Study of Healthcare Innovation, Implementation & Policy [CSHIIP], VA Greater Los Angeles Healthcare System, Los Angeles, CA) Gammage CE (Center for the Study of Healthcare Innovation, Implementation & Policy [CSHIIP], VA Greater Los Angeles Healthcare System, Los Angeles, CA) Saechao FS (Center for Innovation to Implementation [Ci2i], VA Palo Alto Health Care System, Menlo Park, CA) Frayne SM (Center for Innovation to Implementation [Ci2i], VA Palo Alto Health Care System, Menlo Park, CA) Hamilton AB (Center for the Study of Healthcare Innovation, Implementation & Policy [CSHIIP], VA Greater Los Angeles Healthcare System, Los Angeles, CA)

Objectives:
A high rate of attrition has been documented among women Veterans new to Veterans Affairs (VA) healthcare. Patients' interactions and relationships with healthcare providers may influence decisions to stay or leave, thus serving as an important driver of healthcare utilization behavior. This study explored the perspectives and experiences of women Veterans, both attritors and non-attritors from VA care, to understand how patient-provider relationships influenced their decision-making about system-level care-seeking.

Methods:
Between May 2017-August 2018, we conducted semi-structured qualitative telephone interviews with women Veterans from ten VA sites who were new VA users in fiscal year 2011 (n = 51). Women were categorized as attritors if they stopped using VA after a person-specific Year 1 of care (n = 25), or non-attritors if they continued (n = 26). Interviews were audio-recorded, transcribed, and coded for reasons related to remaining in or leaving VA care.

Results:
The patient-provider relationship emerged as one of the most important factors underlying participants' decisions to remain in or leave VA care. Many non-attritors reported highly positive experiences with a trusted VA provider, especially mental healthcare providers; they expressed deep loyalty to these individuals, though not necessarily to the overall VA system. For some, the turnover or departure of these valued providers prompted attrition. Conversely, many attritors reported negative patient-provider experiences, either interpersonal in nature (e.g., a physician with poor bedside manner) or related to questionable medical judgments (e.g., missed diagnoses, overlooked drug interactions); these experiences degraded trust in the VA system overall. Participants recommended patient-centered remedies: hiring more providers, particularly female providers, and offering customer service training to existing staff on how to behave more empathically toward patients.

Implications:
Patient-provider relationships and interactions were meaningful influences at both ends of the utilization spectrum in our sample of women Veterans. Positive experiences with providers were associated with continued use of VA care, while negative experiences were associated with attrition.

Impacts:
In conjunction with efforts to reduce VA provider burnout and turnover, participant recommendations for increasing both provider hiring and providers' social/relational skills inform VA policy and practice changes that may improve Veterans' care experiences.