Study Examines VA's Patient Aligned Care Teams' Challenges in Providing Care for Women Veterans
BACKGROUND:
Over the last decade, VA recommendations for the care of women Veterans have successfully reduced historical gender disparities in care, particularly with regard to screening for mental health conditions (i.e., depression and PTSD). However, in many VA healthcare settings, low volumes of women Veterans make it difficult for providers to remain proficient in gender-specific care and pose other logistical and fiscal barriers to comprehensive care for women Veterans. As VA continues to implement its Patient Aligned Care Team (PACT) medical home initiative, research is needed on how changes introduced as a result of PACT affect care for women Veterans. PACT includes specific guidance for how primary care should be delivered; however, fit between PACT priorities and the provision of comprehensive primary care for women Veterans has not been assessed. In 2014, study investigators conducted interviews with 73 primary care providers and staff in eight VA medical centers to assess provider and staff experiences with PACT, implementation of core medical home features, and facilitators and barriers encountered in providing PACT care to women Veteran patients.
FINDINGS:
- Providers and staff have generally positive attitudes toward PACT. However, early challenges to the delivery of PACT-principled care persist in both primary care and women's health clinics.
- Ongoing barriers to PACT implementation include short staffing, conflicting performance requirements for continuity and same-day access, space constraints, and sharing of support staff across multiple providers.
- Challenges unique to the care of women Veterans included a higher prevalence of psychosocial needs and the need for specialized training of primary care personnel in gender-specific care.
- Providers and staff caring for women Veterans in gender-neutral primary care clinics are typically not able to accommodate longer visits with women Veterans. Primary care providers and staff in women's health clinics are often physically separated from other PACT and medical neighborhood resources or asked to share their support staff with specialists.
IMPLICATIONS:
- Primary care providers and staff face unique challenges in the delivery of comprehensive primary care to women Veterans that may require special policy, practice, and management actions if the full benefits of PACT are to be realized for this patient population.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (CRE-12-026), and Dr. Yano was supported through an HSR&D Senior Research Career Scientist Award. Drs. Hamilton, Rubenstein, and Yano, and Mses. Canelo and Darling are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP).
Chuang E, Brunner J, Mak S, Hamilton A, Canelo I, Darling J, Rubenstein L, and Yano E. Challenges with Implementing a Patient-Centered Medical Home Model for Women Veterans. Women’s Health Issues. March-April 2017;27(2):214-220.
