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Yano EM, Bean-Mayberry B, Lanto A, Washington DL. Barriers to Delivering Quality Care to Women Veterans: Competing Demands, Lack of Proficient Providers, and Inadequate Resources for Outreach. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.
Objectives: Women now constitute nearly 20% of new military recruits, which in turn is reshaping the mix of veterans seen in VA health care settings. This demographic shift represents new challenges to VA providers who have historically seen a heavily male dominated service population. We evaluated the barriers to delivering high quality women's health care in VA medical centers, with a focus on barriers to having adequate clinical competencies among VA providers. Methods: We fielded a national organizational survey (2001) of all chiefs of staff (n = 140) and senior women's health clinicians (n = 166) among VA facilities serving 400 or more women. We linked chief of staffs' reported barriers to delivering their care with site-level senior clinicians' assessments of how VA women's health care was organized and managed. We then examined factors associated with high vs. low reported barriers. Results: We achieved 91% and 82% response rates, respectively. Top-rated barriers included competing local or network priorities (46% moderate-to-large barrier), limited resources for community outreach (43%), inability to recruit specialists (e.g., obstetrics-gynecologists) (38%), small numbers of women veteran users (34%), and insufficient numbers of clinicians skilled in women's healthcare (30%). Barriers were lower in sites with increases in resources dedicated to women's health (p < .001), active tracking of military sexual trauma screening (p < .05), and having adequate local authority for women's health staffing (p < .05). Implications: Substantial barriers to delivering high quality care to women veterans exist throughout the VA, many of which likely require targeted initiatives to overcome competing demands. Recruitment and retention of providers proficient in women's health care delivery, as well as programs focused on outreach and education should be top priorities. Impacts: Returning OEF/OIF women veterans are using VA healthcare at much higher rates than previous cohorts, accelerating demand and bringing barriers to care into full relief. Given the expected doubling of the absolute numbers of women using the VA in the next few years, significant policy action is needed to provide VA managers and providers with the resources, management, and staffing support that this infusion of women will require.