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Original article| Volume 25, ISSUE 1, P28-34, January 2015

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Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans

  • Alicia A. Bergman
    Correspondence
    Correspondence to: Dr. Alicia A. Bergman, PhD, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 Office B-110, North Hills, CA 91343, United States. Phone: +1 (818) 895-9449; Fax: (818) 985-5838.
    Affiliations
    Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana

    Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California
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  • Richard M. Frankel
    Affiliations
    Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana

    Indiana University School of Medicine, Indianapolis, Indiana
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  • Alison B. Hamilton
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California
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  • Elizabeth M. Yano
    Affiliations
    Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California

    Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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      Abstract

      Background

      The growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services.

      Methods

      We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics.

      Results

      Inductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics.

      Conclusion

      Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action.
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      Biography

      Alicia A. Bergman, PhD, is a social scientist and health services researcher with the VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy in Los Angeles, CA. Dr. Bergman's research focuses on communication and women Veterans' health.

      Biography

      Richard M. Frankel, PhD, is Professor of Medicine and Geriatrics at Indiana University School of Medicine and the Associate Director of the VA Center for Healthcare Information and Communication. His research is on the relationship of communication to quality and safety.

      Biography

      Alison Hamilton, PhD, MPH, is a psychiatric anthropologist and health services researcher with the VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, and an Associate Research Anthropologist at UCLA. Dr. Hamilton's work focuses on women Veterans' health.

      Biography

      Elizabeth M. Yano, PhD, MSPH, is Director, VA HSR&D Center for the Study of Innovation, Implementation and Policy, and Adjunct Professor, Health Policy and Management at the UCLA School of Public Health. Her research focuses on primary care delivery models.