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Comparing Practice Arrangements for Women's Health Primary Care Delivery

Goldzweig CL, Washington DL, Simon B, Lanto AB, Yano EM. Comparing Practice Arrangements for Women's Health Primary Care Delivery. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC.


Objectives: VA guidelines recommend that women veterans (WV) receive primary care (PC) from specialized women's clinics or primary care teams. However, practice models vary greatly and 25% of larger VA sites have no designated providers (DP) for women's health. We evaluated differences in experiences of women's health (WH) practice arrangements.Methods: We surveyed Chiefs of Staff (COS) and senior clinicians (SC) in 2001 at all VAs with greater than 400 WV users, using bivariate analysis to compare sites without DPs to those with DPs in PC or women's health clinics (WHCs).Results: 31 sites (mean #WV = 900) had no DPs and 102 sites (mean #WV = 1200) had DPs or WHCs. COS at 53% of sites without DPs indicated that insufficient clinical skills in WH is a moderate to large barrier to delivering high quality WH compared to 22.6% of other sites (p < 0.05). Similarly, SCs at sites without DPs were less likely to report that clinical expertise in general WH is always sufficient (9.4% vs. 33.3%, p < 0.0001). In terms of other resources, sites without DPs were less likely to report that exam rooms are sufficiently equipped for pelvic exams (43% vs. 60.4%, p = 0.06) or that chaperones are always available for exams (40.6% vs. 56.4%, p = 0.056). Service availability was comparable.Conclusions: Sites without DPs appear to face challenges related to clinical expertise and resources in WH despite providing similar services.Impact: Future WH research should address ways to help sites gain greater skill in WH and evaluate how clinical outcomes relate to practice arrangements

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