Availability of Women's Health Clinics, Primary Care Providers, and Women Veterans' Ratings of Care Experiences.

Abstract

Background/objective: VA strives to improve women Veterans' access to comprehensive care. We assessed if availability of specialized clinic arrangements for women or specialized providers (women's health primary care providers) was associated with women Veterans' ratings of primary care experiences.

Design: Cross sectional.

Participants: We linked patient-level survey data (Survey of Healthcare Experiences of Patients, FY 2017, n=4264) with primary care clinic-level data (Clinical Practice Organizational Survey, primary care module, 2017-2018, n=126) from clinics with ≥300 women Veterans.

Main measures: Our dependent variables were derived from top ratings for items rating access, care coordination, comprehensiveness (behavioral health assessed), provider communication, and primary care provider. Our variables of interest were the availability of specialized clinic arrangements such as women's health clinics and specialized providers such as women's health primary care providers.

Statistical analyses: We conducted multi-level, multivariate logistic regression predicting women Veterans' optimal ratings of care, controlling for patient-, clinic-, and area-level characteristics.

Key results: Women Veterans receiving care at general primary care clinics with no women's health primary care providers had a lower likelihood of rating provider communication as optimal (Adjusted Odds Ratio .60, 95%CI .45-.78) or rating the primary care provider as 9 or 10/10 (Adjusted Odds Ratio .61, 95%CI .42-.86). Women Veterans receiving care at VA sites with a gynecology clinic had a higher likelihood of rating access as optimal (Adjusted Odds Ratio 1.40, 95%CI 1.01-1.94).

Conclusions: Our study found that availability of women's health primary care providers in general primary care and availability of gynecology clinics were associated with higher likelihood of women Veterans rating care experiences as optimal. Almost all VA sites have women's health primary care providers available, increasing availability at every site remains an important goal. Relatively few VA community-based outpatient clinics offer gynecology clinics, offering opportunities for improved care experiences among women Veterans.