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GEN 00-082 – HSR&D Study

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GEN 00-082
Women Veterans' Ambulatory Care Use: Patterns, Barriers, and Influences
Donna L Washington MD MPH
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: October 2001 - November 2005

BACKGROUND/RATIONALE:
Women are a small but rapidly growing segment of the veteran population, with estimates that they will comprise 10% of VA healthcare users by the year 2010. The provision of high-quality, comprehensive services for women veterans has been promoted through legislation that authorized VA to provide women’s healthcare services. Though VA facilities have reconfigured themselves to address this legislative mandate, it is unknown if historical deficiencies in access and quality of VA care for women remain.

OBJECTIVE(S):
The objectives of this research are to identify patterns, barriers, and influences on VA women’s health care use from the perspective of women veterans, and to use this information to identify policies and interventions to improve VA women veterans’ health care.

METHODS:
We conducted 6 focus groups and a VISN 22-wide population-based telephone survey of 2,174 women veterans (50%VA-users, 50% VA-nonusers) to assess patterns and determinants of VA and non-VA ambulatory care use. Survey data were merged with a VISN 22 male veteran ambulatory care use dataset to identify gender differences in VA use. Research findings were presented to an expert panel comprised of individuals with different perspectives and levels of involvement in policy, planning and provision of care for women veterans, who identified high priority next steps for improving VA healthcare and access for women veterans.

FINDINGS/RESULTS:
We found significant fragmentation of care, with different components of women’s basic health care being provided by different types of providers and in different settings, with varying degrees of coordination. Primary care and other women’s healthcare were delivered by different providers for 41% of women veterans, irrespective of system of care. Among VA-users, 51% of women veterans split healthcare across VA and non-VA healthcare systems, in contrast to 43% of male veteran VA-users. VA-users were less likely than VA-nonusers to have after-hours access to non-emergency care.

Deterrents to VA use include lack of knowledge of VA eligibility and of available women’s healthcare services, perceptions of poor VA quality of care, and inconvenience of VA care. Younger women veterans had less knowledge about VA eligibility and services than older women veterans, even after controlling for characteristics associated with healthcare need. VA-users have much higher opinions of VA quality of care than VA-nonusers. VA-users and VA-nonusers were equally likely to report appropriate privacy measures in place during their last physical examination. VA availability of a women’s healthcare provider or of a women’s health clinic was a facilitator to VA use.

VA-users had greater physical and mental health co-morbidity than VA-nonusers, and a higher prevalence of military sexual or physical assault (reported by 32% of VA-users, 15% of VA-nonusers).

IMPACT:
This study revealed important barriers to meeting women veterans’ chronic illness care needs. Knowledge gaps should be addressed through dissemination of accurate information about VA eligibility and availability of women’s healthcare services. The high prevalence of military sexual violence suggests the need for additional interventions for it’s prevention and early treatment, and improved mechanisms to get those who screen positive into VA care. Future research should be directed toward identifying determinants of fragmentation of care and of unmet healthcare needs for women with different levels of physical and mental health disease burden. These findings should also be placed within the broader context of national gender differences in veterans’ ambulatory care use.

PUBLICATIONS:

Journal Articles

  1. Washington DL, Yano EM, Simon B, Sun S. To use or not to use. What influences why women veterans choose VA health care. Journal of general internal medicine. 2006 Mar 1; 21 Suppl 3:S11-8.
  2. Washington DL. Challenges to studying and delivering care to special populations--the example of women veterans. Journal of rehabilitation research and development. 2004 Mar 1; 41(2):vii-x.
Reports

  1. Washington DL. VA Women's Health Research. Briefing to the Advisory Committee on Women Veterans. Sepulveda, CA: VA HSR&D Center for the Study of Healthcare Provider Behavior; 2003 Jan 30. Report No.: Technical Monograph #GEN 03-001.
Conference Presentations

  1. Washington DL, Simon BF, Sun S, Canning M, Yano EM. Rape and Assault of Women in the U.S. Military-Prevalence, Treatment and Health Consequences. Paper presented at: Society of General Internal Medicine Annual Meeting; 2005 May 1; New Orleans, LA.
  2. Washington DL, Simon BF, Sasso B, Canning M, Sun S, Yano EM. To Use or Not to Use - Reasons Women Veterans Choose VA vs. Non-VA Health Care. Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.
  3. Washington DL, Simon BF, Sasso B, Sun S, Canning M, Yano EM. Are Women Who Are Raped or Assaulted in the Military Likely to Receive Care? Paper presented at: VA HSR&D National Meeting; 2005 Feb 1; Baltimore, MD.
  4. Washington DL. Gender Disparities in VA Health Care. Paper presented at: VA VHA Senior Leadership Conference; 2004 Aug 14; Washington, DC.
  5. Washington DL, Kleimann S, Michilini AN, Kraft K, Canning M, Yano EM. Do Women Veterans Perceive Gender Disparities in VA Health Care. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC.
  6. Washington DL. Health Care Disparities Beyond Access to Care. Paper presented at: VA HSR&D National Meeting; 2004 Mar 1; Washington, DC.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Epidemiology
Keywords: Access, Primary care, Women - or gender differences
MeSH Terms: Utilization, Ambulatory Care, Health Services Needs and Demand

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