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Determinants of Onsite Availability of the Intrauterine Device at Medical Facilities in the Department of Veteran's Affairs
Cope J, Yano EM. Determinants of Onsite Availability of the Intrauterine Device at Medical Facilities in the Department of Veteran's Affairs. Paper presented at: AcademyHealth Annual Research Meeting; 2004 Jun 11; San Diego, CA.
Objectives: Federal legislative mandates and a rapidly increasing population of women veterans and women in the military has necessitated and accelerated the development of women's health services, including contraceptive services, throughout the VA healthcare system. A safe and effective form of contraception, the intrauterine device (IUD) is already underutilized in the general U.S. population, so availability in VA practice settings where women are a vulnerable minority is of even greater concern. While insurance coverage may explain variations in IUD availability in part, no such limitations exist in the VA. In this study we aim to describe the variation in IUD provision among VA facilities and evaluate the role that contextual and organizational factors play in the onsite availability of this contraceptive.Study Design: We created a composite database consisting primarily of facility-level data obtained form the 2001 VA Survey of Women Veterans health Programs and Practices (n = 136 VA medical facilities). This survey was a cross-sectional assessment of organizational structure and practice through clinical key-informants in each facility. Data from public use data sets and VA administrative databases were linked to further characterize the contextual environment of each facility. Bivariate analyses and multiple logistic regression models were used to evaluate variations in and predictors of onsite IUD availability.Population Studied: All VA medical centers and affiliated community-based outpatient clinics which delivered clinical services to at least 400 unique women during Fiscal year 2000.Principal Findings: While 96% of facilities offer onsite prescription and management of hormonal contraception, 58% offer onsite placement of the IUD. In preliminary logistic models that control for patient volume, sites with a separate gynecology clinic (p = 0.0008), a separate budget for the women's health program (p = 0.01), and a formal women's health training program (p = 0.03) predict availability of onsite IUD placement.Conclusions: Onsite VA provision of contraception is variable. Enhanced clinical specialization and increased control over financial resources in the women's health program may contribute to increased access to various contraceptive methods.Implications: Contraception is an important component of women's health care. More research on how practice structure can facilitate prescription and use of effective contraception is needed.