Rose DE (VA Greater Los Angeles HSR&D Center of Excellence), Washington DL
(VA Greater Los Angeles HSR&D Center of Excellence), Bean-Mayberry BA
(VA Greater Los Angeles HSR&D Center of Excellence), Yano EM
(VA Greater Los Angeles HSR&D Center of Excellence)
Women veterans are enrolling in VA at unprecedented levels, possibly overwhelming providers with limited experience in women’s healthcare. Our objective was to measure how often VAs have adjusted arrangements of primary care services, 2001-2007.
We surveyed VHA senior clinicians in 2001 and 2007 (n = 111 for sites responding to both waves) about practice arrangements for women veterans. In bivariate analyses, we tested for differences in how services were typically provided over time. Services included: pregnancy testing, contraceptive counseling and management, cervical cancer screening, clinical breast examination, evaluation and treatment of vaginitis, menopausal counseling and hormone therapy, osteoporosis management, and sexual trauma screening. Arrangements included: referrals to specialty women's health clinic, or provided by general primary care providers (PCP).
Statistically significant results included: referrals for pregnancy tests decreased (46% in 2001 v. 32% in 2006), while the proportion of sites where PCPs provided tests increased (34% in 2001 v. 49% in 2006) (p < 0.001). Fewer sites reported referring for contraceptive services, (71% in 2001 v. 53% in 2006), while more sites reported that PCPs provided services (8% in 2001 v. 18% in 2006) (p < 0.05). Fewer sites reported referrals for cervical cancer screening (68% in 2001 v. 59% in 2006), while more sites reported PCPs provided screening (6% in 2001 v. 14% in 2006) (p < 0.05). Fewer sites reported referrals for osteoporosis management (46% in 2001 v. 25% in 2006), while more sites reported that PCPs provided osteoporosis management (31% in 2001 v. 51% in 2006) (p < 0.05).
There has been an increase in the proportion of sites having general PCPs offering women’s healthcare services, rather than referring to specialty women’s health clinics.
VAs are working to integrate services for women into primary care, which ought to reduce fragmentation inherent in referral-based arrangements. However, we do not know the proficiency and comfort among gender PCPs regarding care for women veterans. More research is needed to determine whether the shift from referral to specialty women’s health clinics to receiving services from PCPs is accompanied by improvements in patient ratings of care and quality.