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Women's health centers: Predictors of development

Caffrey C, Simon B, Wang M, Yano EM. Women's health centers: Predictors of development. 2001 Apr 15; 16(Supplement 1).


Objectives: Since the inception of Comprehensive Women Veterans Health Centers in 1992 and subsequent directives on the provision of equitable, accessible, high quality care for women veterans, VA facilities have struggled with how to meet their special needs. Some VA's have developed separate Women's Health Clinics for primary care and gender-specific health services delivery. We examined the organizational characteristics and practice features of VA primary care programs that have developed separate primary care clinics for women veterans.Methods: We used data from the 1999 VHA Primary Care Practices Survey, a national survey administered to senior VA primary care leaders at all VA health care facilities with > 4,000 unique patients and > 20,000 outpatient visits during fiscal year 1998 (response rate 93%, n = 219). We analyzed the characteristics of VA facilities associated with the self-reported presence of a VA Women's Health Clinic (WHC) for delivering primary care using bivariate analysis and then examined the independent predictors ofdeveloping a separate WHC using logistic regression.Results: Nationally, 62% of VA's report having formed a separate WHC that provides primary care to women veterans. WHC facilities tend to reside in urban VA's (p < 0.05) and in more complex facilities (p < 0.05). Only somewhat more common in academic VA's (69% vs. 56%, p = 0.09), WHC's are present in VA's with higher numbers of internal medicine houseofficers (43.5 vs. 26.9, p < 0.05) and longer outpatient block rotations (p < 0.05). VA's with WHC's have more female patients (1,279+/-1,277 vs. 740+/-610, p < 0.001) and more visits among them (9,135+/-7,942 vs. 5,465+/-4,839, p < 0.001), but comparable visits-per-patient (7.1 vs.7.4). VA facilities with team-based primary care were more likely to have a WHC (p < 0.05), as were those that integrated family medicine MD's, geriatric MD's, social workers, pharmacists, and dieticians (all p < 0.05) into primary care. VA's with WHC's were more likely to have primary care leadership distinct from subspecialtycare (p < 0.001), but with slightly diffused authority over administrative policies (p < 0.005), ability to contract for primary care services (p < 0.05),and ability to establish referral mechanisms (p < 0.05). Over 80% of VA's reported having sufficient equipment to perform pelvic exams regardless of whether they had a separate WHC. No differences were found in the extent to which VA's with and without WHC's promoted gender-specific guideline adherence through use of reminders or provider education for breast and cervical cancer screening.Conclusions: The liklihood that a VA adopts a separate primary care clinic for women veterans appears to be partly patient-driven (i.e., caseload) and partly organizationally-driven (i.e., level of primary care development; sufficient size permitting division of resources). The implications of separate service delivery with respect to clinical quality, patient satisfaction, and economic efficiency are still unclear and of some debate. Issues of practice management, staffing, and oversight should be studied to determine quality and cost tradeoffs of alternate primary care delivery models for women veterans.Impact: Methods of health care delivery to women veterans are highly variable. More research is needed to examine the organization of women's health care in the VA and to assess practice features associated with better performance and satisfaction.

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