Patient satisfaction in women’s clinics versus traditional primary care clinics in the veterans administration

Abstract

OBJECTIVE:To compare patient satisfaction in women's clinics (WCs) versus traditional primary care clinics (TCs).DESIGN: Anonymous, cross-sectional mailed survey.SETTING: Eight Department of Veterans Affairs (VA) medical centers in 3 states.PATIENTS: A random sample of women stratified by site and enrollment in WC versus TC (total response rate = 61%). MEASURES:Overall satisfaction and gender-specific satisfaction as measured by the Primary Care Satisfaction Survey for Women (PCSSW). ANALYSIS:We dichotomized the satisfaction scores (excellent versus all other), and compared excellent satisfaction in WCs versus TCs using logistic regression, controlling for demographics, health status, health care use, and location.RESULTS: Women enrolled in WCs were more likely than those in TCs to report excellent overall satisfaction (odds ratio, 1.42; 95% confidence interval, 1.00 to 2.02; P = .05). Multivariate models demonstrated that receipt of care in WCs was a significant positive predictor for all 5 satisfaction domains (i.e., getting care, privacy and comfort, communication, complete care, and follow-up care) with the gender-specific satisfaction instrument (PCSSW). CONCLUSIONS:This study is the first to consistently show higher satisfaction in WCs versus TCs despite age and race differences and comparable health status. Since these WCs show better quality in terms of satisfaction, other quality indicators should be evaluated. If WCs reduce fragmentation and improve health care delivery, the model will be applicable in VA and non-VA outpatient settings. 7 These programs vary in their organization, ranging from comprehensive gender-specific primary care delivered by women's health specialists to strictly reproductive care for women. 8 Despite the increasing numbers, few data demonstrate whether specialized women's health centers improve the quality of primary care for women. Two recent studies compared satisfaction, 1 aspect of quality, in specialized women's clinics (WCs) versus traditional primary care clinics (TCs) 1,9 and found similar ratings of overall satisfaction between patients in the 2 settings. While 1 study did find differences along items specific to patientphysician communication, 1 the findings did not impact overall outcomes. However, these studies were limited to a small number of academic practices in a single city serving primarily higher-income women.In contrast, medical centers within the Department of Veterans Affairs (VA) offer the opportunity to compare WCs and TCs in multiple locations with a less affluent population. Since 1992, when the VA began encouraging the development of specialized women's health programs to address disparities for women veterans, 10 a majority (62%) of VA sites report a women's health program or center. 11 We initiated this study to evaluate patient satisfaction among women veterans in WCs versus TCs. On the basis of the concept that comprehensive centers or single systems with multispecialty services 12 provide higher satisfaction, we hypothesized that patient satisf...

Patient-Centered Mental Health Care for Female Veterans

“…These results suggest that women's primary care clinics, which are available at many VHA facilities, are a strategic setting to enhance implementation of women's mental health services through integration of primary care and mental health care (36). These data are also consistent with prior research that has found that designated women's primary care services are associated with greater satisfaction among female veterans (37,38), as well as higher ratings of patient centeredness, such as patient-provider communication, provider's interest in mental health, provider's expertise with women, and shared decision making (39). Future research should examine whether meeting these preferences is similarly associated with greater engagement and satisfaction with mental health services.…”

Healthcare Preferences Among Lesbians: A Focus Group Analysis

“…Results may also not generalize to heterosexual women (especially the lesbian-specific findings), although some of the priorities of women in our sample mirror those of general populations of women participating in parallel studies. 22,39 Results also may not be generalizable to elderly lesbians; the oldest participant in our study was 63 years old. Another limitation is that participants self-identified as lesbian; their responses may not represent the views of lesbians who would be uncomfortable disclosing their sexual orientation in any setting, even a confidential focus group.…”

Access to Care for Women Veterans: Delayed Healthcare and Unmet Need

“…27 Further research should explore patient perception of and navigation among the many VA clinical sites that serve as entry points for OEF/OIF women veteran (e.g., post-deployment clinics, women's clinics, primary care clinics, and mental health clinics). 28 A limitation of this study is that we did not assess the seriousness of the condition for which healthcare was delayed or not obtained, the length or number of delays over 12 months, or the health consequences. Nonetheless, our measure allows comparison with non-veteran populations, and is a useful starting point for a follow-up study to better characterize unmet need and to address potential solutions.…”