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Author List:
Bean-Mayberry BA (Center for Health Equity, Research & Promotion (CHERP))
Caffrey C (Kaiser Permanente, Santa Clarita Valley, CA)
Washington DL (VA Greater Los Angeles Healthcare System)
Lanto AB (VA Greater Los Angeles Healthcare System)
Yano EM (VA Greater Los Angeles Healthcare System)
Objectives:
To examine health system organizational factors associated with the development of separate Department of Veterans Affairs (VA) Women’s Health Clinics that provide primary care services. Such information enables us to understand which environments are conducive to the development of women’s health clinic settings and may be more appropriate for both primary and gender-specific care in the VA Healthcare System.
Methods:
A national, cross-sectional, survey was mailed to primary care (PC) directors at each eligible VA facility. Outpatient health care facilities were compared by administrative patient data and by VA organizational characteristics focused on leadership, staffing, training programs, and affiliations. Each PC director was asked whether their geographically distinct site of care had a women’s health clinic (WHC) that delivered primary care. Multiple logistic regressions were performed to determine the independent factors associated with the development of a separate VA WHC for primary care.
Results:
VA facilities offering a separate WHC for primary care were more likely to have (1) separate primary care leadership (OR 4.0, 95% CI 1.6, 9.7) and (2) separate authority to establish administrative PC procedures (OR 2.7, 95% CI 1.4, 5.1). Presence of other allied health staff within the primary care program (e.g., dietitian and pharmacist) and the presence of established primary group teams (organized provider groups for outpatient clinic coverage) showed similar trends for the development of WHC delivering primary care in bivariate analyses but were not statistically significant in multiple logistic regression.
Implications:
Women’s health clinics that delivery primary care to women veteran users of VA health care services have a stronger likelihood of thriving in settings where the primary care programs are independent, have well-organized leadership with practice autonomy. Such findings may be more influential than general female patient volume or workload.
Impacts:
More research and practice evaluations are needed to determine the quality of care afforded to women who choose to attend these clinics in contrast to general primary care clinics. Such information will be crucial to designing effective primary care programs for our rapidly growing female veteran population.
