The Focus They Deserve: Improving Women Veterans' Health Care Access.

Affiliation

Marshall V(1), Stryczek KC(2), Haverhals L(3), Young J(4), Au DH(5), Ho PM(6), Kaboli PJ(7), Kirsh S(8), Sayre G(9).
Author information:
(1)VA Northeast Ohio Healthcare System, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.
(2)VA Northeast Ohio Healthcare System, Cleveland, Ohio. Electronic address: [Email]
(3)VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado.
(4)VA Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.
(5)VA Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington.
(6)VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado; Department of Medicine, University of Colorado, Aurora, Colorado.
(7)Center for Access and Delivery Research and Evaluation
(CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
(8)The U.S. Department of Veterans Affairs Central Office, Washington, District of Columbia.
(9)VA Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.

Abstract

PURPOSE: Veterans Health Administration (VHA) initiatives aim to provide veterans timely access to quality health care. The focus of this analysis was provider and staff perspectives on women veterans' access in the context of national efforts to improve veterans' access to care. METHODS: We completed 21 site visits at Veterans Health Administration medical facilities to evaluate the implementation of a national access initiative. Qualitative data collection included semistructured interviews (n = 127), focus groups (n = 81), and observations with local leadership, administrators, providers, and support staff across primary and specialty care services at each facility. Deductive and inductive content analysis was used to identify barriers, facilitators, and contextual factors affecting implementation of initiatives and women veterans' access. RESULTS: Participants identified barriers to women veterans' access and strategies used to improve access. Barriers included a limited availability of providers trained in women's health and gender-specific care services (e.g., women's specialty care), inefficient referral and coordination with community providers, and psychosocial factors (e.g., childcare). Participants also identified issues related to childcare and perceived harassment in medical facility settings as distinct access issues for women veterans. Strategies focused on increasing internal capacity to provide on-site women's comprehensive care and specialty services by streamlining provider training and credentialing, contracting providers, using telehealth, and improving access to community providers to fill gaps in women's services. Participants also highlighted efforts to improve gender-sensitive care delivery. CONCLUSIONS: Although some issues affect all veterans, problems with community care referrals may disproportionately affect women veterans' access owing to a necessary reliance on community care for a range of gender-specific services.