Women Veterans represent the fastest-growing proportion of patients in the VA healthcare system - and are expected to make up 14% of the Veteran population by 2030.1
The VA healthcare system has established policies and programs to meet the demands of a rapidly growing patient population of women Veterans. National VA policies have led to important advancements in providing comprehensive, gender-sensitive care for women, and local leadership plays a vital role in implementing these national priorities. In this issue of Veterans’ Perspective, we focus on the voices of VA stakeholders who discuss their vision of “ideal” care for women Veterans.
Evidence to date about women Veterans’ healthcare and the factors that improve it necessarily comes from many sources, including women Veterans themselves. However, a growing body of literature has demonstrated the importance of gathering evidence not only from patients and providers, but also from leaders, namely, the practitioners and decision-makers who translate policy into practice, and who face difficult trade-offs in pursuing improved quality of care.
As part of a multisite implementation trial of evidence-based quality improvement for tailoring PACT (Patient Aligned Care Teams) to women Veterans’ healthcare needs, investigators with this HSR&D-funded study conducted interviews with 86 local leaders from May through December 2014. Participants spanned 12 VA medical centers (VAMCs) and 4 Veterans Integrated Service Networks (VISNs), and included VAMC and VISN leadership, women's health medical directors, women's health program managers, and other relevant roles (e.g., leaders in quality measurement/improvement, informatics). At the conclusion of interviews about women’s primary care, participants were asked to describe their conceptualizations of “ideal care” for women Veterans.
In describing ideal care, overall, study participants commonly discussed:
- Whether women Veterans should have separate primary care services from men;
- The need for childcare, expanded reproductive health services, resources, and staffing;
- Geographic accessibility;
- The value of input from women Veterans;
- The physical appearance of facilities;
- Fostering active interest in women’s health across providers and staff; and
- The relative priority of women’s health at VA.
“I think this whole effort to change the conversation and return the focus to patients and what’s important to them in their lives is really the direction that we want to go – not only with women’s health, but with all of the healthcare that we deliver.”
“Well, I think [ideal care] would involve a great deal of choice for women Veterans… I am of two minds with this because I’ve had women Veterans tell me both sides of the coin. Some say, ‘Hey, I served… I don’t need anything special; I don’t want my care separate.’ Then we talk to other women Veterans that say, ‘I really want my own clinic; I want it to be separate.’”
“If I had my wish, the medical center directors would be required to make [women’s health] a priority and not the stepchild. My biggest complaint is that whenever primary care staff are down, they pull people who work in women’s health clinic to fill in primary care.”
“We still don’t have adequate resources primarily around support staff and care coordination. So from my perspective here, where we have plenty of designated women’s health providers, we still have issues with, number one – we need more co-located mental health; number two – we need greater resources for care coordination.”
“I think that the culture change within the hospitals and within VA, in general, is really, really, really important. I’ve actually seen it change here over the last couple of years. I really feel it from the other providers in other areas, like in mental health, that people get the message of ‘it’s everyone’s job to take care of women Veterans.”
“As we get younger and younger Vets coming in, we need to get more comfortable with family planning issues, contraception, and how to be very women-centered in terms of how we administer, initiate and continue contraception.”
“I’d love to see Congress approve childcare for patients [children] in our facilities. We have been asking for a long time for that.”
Study results have been presented to VA operations leaders in Women’s Health Services. Study investigators anticipate providing further briefings to other audiences (e.g., primary care) as they continue to learn from this trial of gender-tailored primary care.
Considering feedback provided in this study, the investigators suggest that paths toward ideal care for women Veterans include:
- Projecting and anticipating growth in women’s health programs;
- Building on VA’s pilot program to provide childcare for patients’ children during visits;
- Designing a hiring process to more consistently recruit providers with a strong interest in caring for women; and
- Conducting listening sessions and creating other opportunities that allow senior VA leadership to hear women Veterans’ perspectives and preferences directly.
The parent study was conducted in partnership with the Office of Women’s Health Services, and in collaboration with the VA Women’s Health Research Network through use of sites within the VA Women’s Health Practice-Based Research Network. This study was conducted in VISNs 1 (VA New England Healthcare System), 4 (VA Pennsylvania Health Care), 12 (VA Great Lakes Health Care System) and 23 (VA Midwest Health Care Network) – and involved their leadership, as well as leaders of the 12 participating VA Medical Centers.
For more information about this study, please contact Julian Brunner, PhD, MPH, part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, at Julian.Brunner@va.gov .
- Brunner J, Cain C, Yano E, and Hamilton A. Local Leaders’ Perspectives on Women Veterans’ Health Care: What Would Ideal Look Like? Women’s Health Issues. Jan-Feb, 2019;29(1):64-71.