Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans

Abstract

The growing presence of women Veterans in Veterans Health 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 women's health 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 them 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 to women Veterans' primary care needs. We 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 (CBOCs). Inductive 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. Although 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 multi-factorial and likely multi-level in nature, and may therefore require special policy and practice action.

Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans’ experience with VA care

“…Women Veterans (WVs) constitute the fastest growing segment of VA patients, but represent a numerical minority within VA facilities (<10 percent of VA users) . Delivering women's health (WH) services, maintaining provider competencies in WH, and providing gender‐sensitive care environments have been challenging for VA facilities traditionally oriented toward the care of male patients . Furthermore, while overall the need for specific gender‐related care has increased across VA due to changes in patient demographics and significant increases in enrollment of younger female patients, individual facilities may still lack the ability to deliver this type of care as locally it represents a low volume of patients .…”

“…6 Delivering women's health (WH) services, maintaining provider competencies in WH, and providing gender-sensitive care environments have been challenging for VA facilities traditionally oriented toward the care of male patients. [7][8][9] Furthermore, while overall the need for specific genderrelated care has increased across VA due to changes in patient demographics and significant increases in enrollment of younger female patients, individual facilities may still lack the ability to deliver this type of care as locally it represents a low volume of patients. 10,11 VA efforts to improve the care of WVs have focused on implementing comprehensive primary care models that are tailored to WV needs, 12,13 and also aligned with WVs' preferences for receiving WH services and primary care (PC) from the same source.…”

Community Health Center Engagement and Training During Obstetrics and Gynecology Residency

“…We included Veterans Affairs institutions as a training opportunity for medically underserved populations due to its limited women's health services. 12,13 Respondents also reported the expected number of graduating residents from the current and previous academic years who plan to work in a CHC, FQHC, or another underserved community setting. Lastly, respondents had an opportunity to name barriers that prevent residents from training at CHCs.…”

Five‐year trend in healthcare access and patient‐reported health outcomes among women veterans

“…The Veterans health administration (VHA), which provides care for Veterans was originally designed to deliver care to a male Veteran majority . However, the number of women Veterans seeking care from the VHA has increased from 674,784 in 2011 to 836,191 in 2015 .…”