Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans |
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| Institution: | 1. Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana;2. Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California;3. Indiana University School of Medicine, Indianapolis, Indiana;4. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California;1. VA Boston Healthcare System, Boston, Massachusetts;2. Boston University School of Public Health, Boston, Massachusetts;3. Boston University School of Medicine, Boston, Massachusetts;4. Boston University School of Dental Medicine, Boston, Massachusetts;1. VA Center for Health Equity Research and Promotion, Philadelphia Pennsylvania;2. National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts;3. Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts;1. Center for Health Equity Research and Promotion (CHERP), Philadelphia VA Medical Center, Philadelphia, Pennsylvania;2. VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts;3. Quantitative Health Sciences & Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts;1. VA Connecticut Healthcare System, West Haven, Connecticut;2. University of Connecticut Health Center, Farmington, Connecticut;3. VA Connecticut Healthcare System, West Haven, Connecticut;4. Veterans Health Administration Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California;5. Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California;6. Office of Performance Measurement, Department of Veterans Affairs, Providence, Rhode Island;7. Department of Veterans Affairs, Pittsburgh, Pennsylvania;8. Office of Performance Measurement, Office of Analytics & Business Intelligence, Durham, North Carolina;9. Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California;10. Women''s Health Services, Patient Care Services, VA Central Office, VA Connecticut Healthcare System Yale School of Medicine, West Haven, Connecticut;1. Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, VA Medical Center, Seattle, Washington;2. Women''s Veterans Health Services, Office of Patient Services, VA Central Office, Washington, DC;3. Department of Health Services, University of Washington School of Public Health, Seattle, Washington;4. VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California;5. Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California;6. Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington;7. Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California;8. Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, New York |
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| Abstract: | BackgroundThe growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services.MethodsWe conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics.ResultsInductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics.ConclusionAlthough adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action. |
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