Readying the workforce: evaluation of VHA's comprehensive women's health primary care provider initiative. 2015

Natalya C Maisel, and Sally Haskell, and Patricia M Hayes, and Vidhya Balasubramanian, and Anupama Torgal, and Lakshmi Ananth, and Fay Saechao, and Samina Iqbal, and Ciaran S Phibbs, and Susan M Frayne
*Women's Health Evaluation Initiative (WHEI), Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA †Women's Health Services, VA Central Office, Washington, DC ‡Health Economics Resource Center §Women's Health Service, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA ∥Division of General Medical Disciplines ¶Department of Pediatrics #Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA.

BACKGROUND Veterans Health Administration (VHA) primary care providers (PCPs) often see few women, making it challenging to maintain proficiency in women's health (WH). Therefore, VHA in 2010 established Designated WH Providers, who would maintain proficiency in comprehensive WH care and be preferentially assigned women patients. OBJECTIVE To evaluate early implementation of this national policy. METHODS At each VHA health care system (N=140), the Women Veterans Program Manager completed a Fiscal Year 2012 workforce capacity assessment (response rate, 100%), representing the first time the national Designated WH Provider workforce had been identified. Assessment data were linked to administrative data. RESULTS Of all VHA PCPs, 23% were Designated WH Providers; 100% of health care systems and 83% of community clinics had at least 1 Designated WH Provider. On average, women veterans comprised 19% (SD=27%) of the patients Designated WH Providers saw in primary care, versus 5% (SD=7%) for Other PCPs (P<0.001). For women veterans using primary care (N=313,033), new patients were less likely to see a Designated WH Provider than established women veteran patients (52% vs. 64%; P<0.001). CONCLUSIONS VHA has achieved its goal of a Designated WH Provider in every health care system, and is approaching its goal of a Designated WH Provider at every hospital/community clinic. Designated WH Providers see more women than do Other PCPs. However, as the volume of women patients remains low for many providers, attention to alternative approaches to maintaining proficiency may prove necessary, and barriers to assigning new women patients to Designated WH Providers merit attention.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011320 Primary Health Care Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192) Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D003191 Comprehensive Health Care Providing for the full range of personal health services for diagnosis, treatment, follow-up and rehabilitation of patients. Comprehensive Healthcare,Health Care, Comprehensive,Healthcare, Comprehensive
D005260 Female Females
D006291 Health Policy Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. Health Care Policies,Health Policies,Healthcare Policy,National Health Policy,Care Policies, Health,Health Care Policy,Health Policy, National,Healthcare Policies,National Health Policies,Policies, Health,Policies, Health Care,Policies, Healthcare,Policy, Health,Policy, Health Care,Policy, Healthcare
D006297 Health Services Accessibility The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others. Access To Care, Health,Access to Care,Access to Contraception,Access to Health Care,Access to Health Services,Access to Medications,Access to Medicines,Access to Therapy,Access to Treatment,Accessibility of Health Services,Availability of Health Services,Contraception Access,Contraceptive Access,Medication Access,Accessibility, Health Services,Contraceptive Availability,Health Services Geographic Accessibility,Program Accessibility,Access to Cares,Access to Contraceptions,Access to Medication,Access to Medicine,Access to Therapies,Access to Treatments,Access, Contraception,Access, Contraceptive,Access, Medication,Accessibilities, Health Services,Accessibility, Program,Availability, Contraceptive,Care, Access to,Cares, Access to,Contraception, Access to,Contraceptive Accesses,Health Services Availability,Medication Accesses,Medication, Access to,Medicine, Access to,Medicines, Access to,Therapy, Access to,Treatment, Access to
D006787 Hospitals, Veterans Hospitals providing medical care to veterans of wars. Veterans Hospitals,Hospital, Veterans,Veterans Hospital
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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