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)
Through Congressional support and administrative planning, the VA healthcare system has increased the provision of basic and specialty services for women veterans, in recognition of their growing numbers and unmet needs. However, little is known about how well VA sites have been able to maintain on-site access to services over time, given limited resources and competing priorities.
We surveyed VHA senior women’s health clinicians about specialty services available on-site for women veterans in 2001 and 2007 (n = 113 for sites responding to both waves). In bivariate analyses, we tested for changes over time. Services included: screening and diagnostic mammography, cervical cancer screening, evaluation and treatment of vaginitis, menstrual disorders and menopause, endometrial biopsy, prescription and management of contraceptives (e.g., hormones, IUD), infertility counseling, breast cancer surgery, non-surgical or adjuvant breast cancer treatment, and general gynecological surgery.
The proportion of VAs offering screening or diagnostic mammograms on-site decreased from 31% to 18%, and 28% to 17%, respectively (p < 0.001 for both). The proportion of VAs offering breast cancer surgery for non-surgical breast cancer or adjuvant breast cancer treatment decreased from 59% to 48% (p < 0.001), and 63% to 57% (p < 0.001), respectively. Fewer VAs offered gynecological surgery on-site, decreasing from 57% to 44% (p < 0.001) and showed decreases in outpatient procedures, such as treatment for menstrual disorders, endometrial biopsy, hormonal and IUD contraception, menopausal management, and prenatal care (p < 0.05 for all).
Women’s specialty health services became less available on-site over the past 6 years, with women increasingly having their specialty care transferred to other VAs or community providers.
The results show a striking erosion in the number of services for women veterans available on-site. As the proportion of women veterans using the VA continues to increase, definitive strategies are needed to ensure consistent and appropriate follow-up of women requiring specialty care to avoid further fragmentation in care and unforeseen gaps in care quality.