Original Article

Women’s Health Provider Perspectives on Reproductive Services Provision in the Veterans Health Administration

Authors: Lori M. Gawron, MD, MPH, Jeanette Young, MACL, Serena Yang, BS, Patrick Galyean, BS, Lisa S. Callegari, MD, Alexandra Gero, MPH, Rebecca G. Simmons, PhD, Morgan M. Millar, PhD, Susan L. Zickmund, PhD

Abstract

Objectives: Women veterans are a fast-growing population in the Veterans Health Administration (VHA), and ensuring reproductive service availability is a VHA priority. As such, we sought to explore barriers and facilitators to VHA reproductive service provision across a catchment area from women’s health providers’ perspectives.

Methods: We performed a mixed-methods study, including semistructured, qualitative provider interviews with a quantitative survey on training, comfort, and knowledge of reproductive services. All women’s health providers and their support staff from the Salt Lake City Veterans Affairs Medical Center and nine VHA community-based outpatient clinics were asked to participate. We conducted qualitative interviews and knowledge surveys with providers and staff to explore training, care processes, and improvement opportunities in reproductive service provision. We completed descriptive analyses of all of the quantitative data and used an open, iterative process to analyze provider interviews for emergent themes.

Results: We interviewed 15 providers (7 advanced practice nurses, 4 registered nurses, and 4 physicians) across nine sites (50% response rate). The commonly identified barriers included provider training and staffing, scheduling/referral processes, inconsistent services/supplies, and lack of veteran awareness of reproductive services. Facilitators included prior non-VHA reproductive health experience among providers, invested support staff, and the integrated VHA health system.

Conclusions: Addressing barriers to VHA reproductive healthcare provision may overcome reproductive service variations related to clinic location and improve reproductive health outcomes for women veterans.
Posted in: Family Planning & Reproductive Health14

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References

1. Frayne SM, Phibbs CS, Saechao F, et al. Sourcebook: women veterans in the Veterans Health Administration. Vol. 4. Longitudinal trends in sociodemographics, utilization, health profile and geographic distribution. https://www.womenshealth.va.gov/WOMENSHEALTH/docs/WHS_Sourcebook_Vol-IV_508c.pdf. Published 2018. Accessed February 2, 2021.
 
2. Gawron LM, Redd A, Suo Y, et al. Long-acting reversible contraception among homeless women veterans with chronic health conditions: a retrospective cohort study. Medical Care 2017;55(4 suppl 9):S111–S120.
 
3. Gray KE, Katon JG, Callegari LS, et al. Gynecologists in the VA: do they enhance availability of sex-specific services and policies in the emergency department? Medical Care 2015;53(4 suppl 1):S76–S80.
 
4. Department of Veterans Office of Public Affairs. Women veterans population. https://www.va.gov/womenvet/docs/WomenVeteransPopulationFactSheet.pdf. Published November 22, 2019. Accessed November 7, 2020.
 
5. Seelig MD, Yano EM, Bean-Mayberry B, et al. Availability of gynecologic services in the Department of Veterans Affairs. Womens Health Issues 2008;18:167–173.
 
6. Bean-Mayberry B, Bastian L, Trentalange M, et al. Associations between provider designation and female-specific cancer screening in women veterans. Medical Care 2015;53(4 suppl 1):S47–S54.
 
7. Bastian LA, Trentalange M, Murphy TE, et al. Association between women veteran’s experiences with VA outpatient health care and designation as women’s health provider in primary care clinics. Womens Health Issues 2014;24:605–612.
 
8. Katon J, Reiber G, Rose D, et al. VA location and structural factors associated with on-site availability of reproductive health services. J Gen Intern Med 2013;28(suppl 2):S591–S597.
 
9. Cope JR, Yano EM, Lee ML, et al. Determinants of contraceptive availability at medical facilities in the Department of Veterans Affairs. J Gen Intern Med 2006;21(suppl 3):S33–S39.
 
10. Schartz R, Frayne SM, Freidman S, et al. Retaining VAwomen’s health primary care providers: work setting matters. J Gen Intern Med 2021;36:614–621.
 
11. Department of Veterans Affairs. VHA directive 1330.01(6). Health care services for women veterans. https://www.va.gov/vhapublications/ViewPublication.asp? pub_ID=5332. Published February 15, 2017. Accessed November 7, 2020.
 
12. Maisel NC, Haskell S, Hayes PM, et al. Readying the workforce: evaluation of VHA’s comprehensive women’s health primary care provider initiative. Medical Care 2015;53(4 suppl 1):S39–S46.
 
13. Quinn DA, Edmonds SW, Zhao X, et al. Veteran-reported receipt of prepregnancy care: data from the Examining Contraceptive Use and Unmet Need (ECUUN) study. Matern Child Health J 2021;25:1254–1264.
 
14. Judge-Golden CP, Wolgemuth TE, Zhao X, et al. Agreement between self-reported “ideal” and currently used contraceptive methods among women veterans using the Veterans Affairs Healthcare System. Womens Health Issues 2020;30:283–291.
 
15. Marsa L. Labor pains: the OBGYN shortage. https://www.aamc.org/news-insights/labor-pains-ob-gyn-shortage. Published 2018. Accessed January 2, 2021.
 
16. Department of Veterans Affairs. Study of barriers for women veterans to VA health care: final report. https://www.womenshealth.va.gov/docs/Womens%20Health%20Services_Barriers%20to%20Care%20Final%20Report_April2015.pdf. Published April 2015. Accessed September 18, 2020.
 
17. Bergman AA, Frankel RM, Hamilton AB, et al. Challenges with delivering gender-specific and comprehensive primary care to women veterans. Womens Health Issues 2015;25:28–34.
 
18. Morse JM, Niehaus L. The nuts and bolts of mixed method design. In: Mixed Method Design: Principles and Procedures. New York: Routledge; 2016: 23–37.
 
19. Crabtree BF, Miller WL. Doing Qualitative Research, Vol. 2. Thousand Oaks, CA: Sage Publications; 1999.
 
20. Pugh MJ, Leykum LK, Lanham HJ, et al. Implementation of the Epilepsy Center of Excellence to improve access to and quality of care—protocol for a mixed methods study. Implement Sci 2014;9:44.
 
21. Gawron LM, Turok DK. Pills on the world wide web: reducing barriers through technology. Am J Obstet Gynecol 2015;213:500.e1–500.e4.
 
22. Wenzel SG, Risley KY. Providing comprehensive contraceptive services in primary care at a rural federally-qualified health center in the USA: adapting to patient need in a culturally-conservative, rural environment. Rural Remote Health 2021;21:6308.
 
23. Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: a systematic review of reviews. Annu Rev Public Health 2015;36:393–415.
 
24. Kapu AN, Card E, Jackson H, et al. Development and testing of an advanced practice clinical advancement program within an academic medical center. J Am Assoc Nurse Pract 2020;33:719–727.
 
25. Terry DL, Woo MJ. Burnout, job satisfaction, and work-family conflict among rural medical providers. Psychol Health Med 2021;26:196–203.
 
26. Wilkinson TA, Kottke MJ, Berlan ED. Providing contraception for young people during a pandemic is essential health care. JAMA Pediatr 2020;174: 823–824.
 
27. Callegari LS, Nelson KM, Arterburn DE, et al. Development and pilot testing of a patient-centered, web-based reproductive decision support tool for primary care. J Gen Intern Med 2021;36:2989–2999.