Does a Welcoming Environment Influence Women Veterans' Primary Care Experiences?

Rose DE, Farmer MM, Oishi SM, Klap RS, Bean-Mayberry BA, Canelo I, Washington DL, Yano EM. Does a Welcoming Environment Influence Women Veterans' Primary Care Experiences? Women's health issues : official publication of the Jacobs Institute of Women's Health. 2024 Aug 28; 34(5):540-548.

Related HSR&D Project(s)

• CRE 12-038 – Impacts of Delivery of Comprehensive Women's Health Care in the VA
• RCS 05-195 – Research Career Scientist Award
• CRE 12-008 – Evaluation of Quality and Coordination of Outsourced Care for Women Veterans

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Abstract:

BACKGROUND: A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8-10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes. PROCEDURES: We merged national patient-reported outcomes from women veterans (n  =  4,961) using Consumer Assessment of Health Plans and Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers'' reports of gender-related environment of care problems (n  =  127, 2016-2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers'' reports of large/extreme problems and likelihood of women veterans'' optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers. MAIN FINDINGS: Few ( < 15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal. PRINCIPAL CONCLUSIONS: Ensuring a welcoming environment may improve women veterans'' primary care experiences.