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How is VA Health Care Organized for Women Veterans?: Results of a National Survey

Yano EM, Caffrey C, Goldzweig C, Washington D, Altman L, Simon BF, Canelo I, Turner C. How is VA Health Care Organized for Women Veterans?: Results of a National Survey. Paper presented at: VA HSR&D National Meeting; 2002 Feb 1; Washington, DC.


Objectives: Charged by the Under Secretary for Health to develop evidence-based strategic recommendations for improving care delivery for women veterans, the National Women Veterans Health Strategic Work Group sponsored an assessment of how women veterans' health care is organized nationwide. Methods: We worked with work group members to prioritize domains for a multi-level survey of VISN leaders, Chiefs of Staff and Senior Women's Health Clinicians to measure variations in policy development, practice organization, management and quality. We adapted questions from the NIH Women's Health Centers of Excellence evaluation (Weisman/Scholle) and previous VA surveys, and created new items to assess unique aspects of women veterans' care organization. For this analysis, we analyzed responses among Senior Clinicians of VA facilities serving 400 or more women veterans (N = 166) in 2001. Results: We received 133 (80%) senior-clinician surveys. Both mental health (MH) and primary care (PC) are mostly delivered in settings with men (50% and 40% completely integrated, respectively), although respondents anticipate shifting to more separate arrangements. Most VA's (57%) report that the majority of women veterans obtain care in general PC clinics; fewer than half have designated women's health providers. Most VA's (56%) also have a separate women's health clinic (WHC). WHCs provide mostly gynecologic (82%) and primary care (76%), but also provide some social work (41%), pharmacy (34%), mental health (33%), nutrition (31%) and obstetric services (13%). Overlaps in services between PC and WHCs may be explained in part by PC referrals to WHCs for most gender-specific services (e.g., contraceptive counseling, Paps, hormone replacement therapy) where women are also much more likely to see same-gender providers. Over half also note separate Gynecology clinics (59%). About 40% have designated women's health providers within outpatient MH and 10% have developed separate women's MH clinics. Conclusions: VA facilities have adopted complex health care delivery arrangements for women veterans, comprising a diverse array of both integrated and separate clinics. These arrangements appear to reflect eclectic variations rather than purposeful, organized practice structures. Impact statement: Equitable health care delivery for women veterans is difficult given their extreme minority in VA settings. Currently, the effectiveness of the highly variable care arrangements for women veterans remains unclear.

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