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Washington DL, Goldzweig C, Simon BF, Yano EM. VA Emergency Healthcare for Women: Condition-Critical or Stable? Paper presented at: VA HSR&D National Meeting; 2003 Feb 13; Washington, DC.
Objectives: Women are a small but rapidly growing segment of the veteran population, with estimates that they will comprise 10% of VA users within the next decade. The provision of high-quality, comprehensive services for women veterans has been promoted through legislation that authorized VA to provide gender-specific services. Though VA facilities have reconfigured themselves to address this legislative mandate, the challenge of providing comprehensive care to a group that is an extreme minority within VA may leave gaps in the delivery of necessary healthcare services. Methods: In a VA-wide survey of all facilities serving 400 or more women veterans, we assessed the availability of a women's healthcare specialist for emergency gynecologic problems (emergency-GYN) and emergency mental health conditions specific to women (EWMH). Facility-level characteristics were available for 118 respondents from administrative data sources, a chief-of-staff and a senior clinician survey. Results: Emergency-GYN expertise was usually available at all times for 39.8% of sites, and during usual clinic hours only for 24.6% of sites. An EWMH-specialist was available at all times for 51.7% of sites, and during usual clinic hours only for 31.0% of sites. Emergency-GYN expertise and EWMH-specialists were not usually available, even during clinic hours, for 35.6% and 17.2% of sites, respectively. Having a separate women's health clinic and lower local managed care penetration were independently associated with emergency-GYN (p = .033) and EWMH (p = .024) availability, respectively. Organizational complexity, tracking of women veterans' satisfaction, perceived women's health resource sufficiency, having designated providers for women in general primary care and mental health clinics, and having a women's health training program were not independently associated. Conclusions: Though many VA facilities have the available expertise to provide emergency care to women veterans, a significant proportion do not, particularly for after-hours care. Sites in areas with less managed care penetration are more likely to have EWMH availability, perhaps filling a niche for services less widely available in their local private sector. Impact: Further work is needed to determine how clinicians respond when such expertise is needed. Options for addressing this gap include internal development of women's health expertise, and tele-medicine access to experts to aid in emergency women's healthcare decision-making.