Study Suggests Women Veterans have Better VA Outpatient Care Experiences with Designated Women's Health Providers
BACKGROUND:
In 2010, VA established a policy requiring the provision of comprehensive women's healthcare by designated women's health providers (DWHPs). Per VA policy, DWHPs are primary care providers who are proficient and interested in women's health, and who are preferentially assigned women Veterans. DWHPs may practice in Comprehensive Women's Clinics or in mixed-gender primary care clinics; however, little is known about the quality of healthcare delivered by DWHPs and women Veterans' experience with this care. This cross-sectional operational analysis examined whether women Veterans' experiences with care were better for patients seen by DWHPs compared to those seen by non-DWHPs. Investigators conducted a secondary data analysis of the VA Survey of Healthcare Experience of Patients (SHEP) and included 8,151 women Veterans who were seen by 3,147 VA primary care providers (40% or 1,276 were DWHPs). Surveys assessed patients' experiences between March 2012 and February 2013. Data analyzed in this study also included provider characteristics (e.g., age and provider class – M.D., nurse practitioner, physician assistant) and patient characteristics (e.g., demographics, self-reported health and mental health status, frequency of seeing provider).
FINDINGS:
- Women Veterans' overall experiences with outpatient healthcare were slightly better for those receiving care from DWHPs compared to those receiving care from non-DWHPs. Differences in patient experiences were not mitigated after adjusting for variables.
- Compared to women Veterans seeing DWHPs versus non-DWHPs, women Veterans' experiences for six outpatient composites were: Access (42.1 vs. 37.7), Communication (74.1 vs. 71.0), Shared decision-making (61.6 vs. 58.8), Self-management support (56.0 vs. 50.3), Comprehensiveness (67.4 vs. 62.0), and Office Staff (66.0 vs. 64.4).
- Although the majority of DWHPs were physicians (62%), more DWHPs were nurse practitioners (NPs) compared to non-DWHPs (31% vs. 16%). Veterans seeing NPs had significantly better experiences than those seeing MDs (regardless of DWHP status).
- Provider gender was not independently associated with experiences with care.
- Compared to women Veterans seeing non-DWHPs, women Veterans seeing DWHPs were younger and reported better health status.
LIMITATIONS:
- One limitation of the survey used in this study is that the SHEP questions were not specific to women's health needs or their gender-specific experiences within the VA healthcare system, so it is unclear whether scores actually reflect better care experience.
- Mail-based surveys yield less positive evaluations of care than other survey modalities.
IMPLICATIONS:
- These findings support increased access to DWHPs at VA primary care clinics.
Bastian L, Trentalange M, Murphy T, et al. Association between Women Veterans’ Experiences with VA Outpatient Healthcare and Designation as a Women’s Health Provider in Primary Care Clinics. Women’s Health Issues. November-December 2014;24(6):605-12.
