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Practice Structure of Women Veterans Health Care in VA Medical Centers

Yano EM, Washington D, Goldzweig C, Caffrey C, Altman L, Simon BF, Canelo I, Turner C. Practice Structure of Women Veterans Health Care in VA Medical Centers. Paper presented at: Society of General Internal Medicine Annual Meeting; 2002 May 1; Atlanta, GA.


BACKGROUND Congressional eligibility reforms have profoundly changed the array of services to be made available to women veterans in all Department of Veterans Affairs (VA) health care facilities. These include not only primary and specialty care services already afforded VA users, but also a full spectrum of gender-specific services, including prenatal, obstetric and infertility services never before provided in VA settings. The implications of this legislative mandate are poorly understood, especially since no information has been available on how care is currently structured. METHODS We surveyed senior women's health clinicians at VAs serving 400 or more women veterans (82% response rate, n = 136). We adapted questions from the NIH Women's Health Centers of Excellence evaluation and previous VA surveys to assess practice structure (clinic organization, services available, privacy arrangements, clinic hours). Univariate and bivariate analyses were conducted to assess national and regional variations. RESULTS Overall, 46% of VAs have one or more designated women's health providers in primary care (48% one, 9% one/team, 31% full team). While the majority of care for women veterans is in primary care, 54% also have separate women's health clinics (WHCs), where they principally provide gender-specific services (e.g., reproductive health, osteoporosis management); women are more likely to see same-gender providers with more privacy (i.e., exclusive use of exam and waiting rooms). Gynecology clinics exist in 58% of VAs, separate from WHCs, and focus on surgical specialty care. Mental health is provided principally in integrated mental health (MH) clinics, with 43% having one or more designated women's health providers. Only 11% have specialized women's MH clinics. Greater separation of services is more common in primary care than for mental health services. CONCLUSION VA facilities have adopted complex health care delivery arrangements for women veterans, which may reflect eclectic local variations more than purposeful practice structures. Reducing women veterans' health disparities will require innovative care models and referral networks to achieve equitable, high quality care for this extreme minority.

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