|
The number of women veterans utilizing
VA health care will likely double in the next
2 to 4 years. Given this growth, the VA
must evaluate current services and develop
an implementation plan to enhance services
for women veterans.
Women veterans have been chronically underserved
by VA. The market penetration
for women from 2003 to 2007 increased
only from 11 percent to 14.6 percent, while
the market penetration for male veterans
during the same period was consistently at
22 percent.1 In addition, we know that even
while utilizing VA services, women more
often have sought outside services than
have men, especially for women’s gynecological
conditions.2
A very worrisome outcome of our predominant
models of primary care is fragmentation,
with women seeing one provider for
primary care, and another in a separate clinic
visit for gender-specific care. VA recently
released data indicating poorer performance
for women vs. men on quality clinical indicators,
raising questions about the overall
care provision to women and how examination
of the various models of care might
inform quality improvement efforts.
Women's view of health care varies on their
own particular experience and whether they
see a primary care internal medicine practitioner,
a family medicine provider, or an
Ob/Gyn who meets most or all of their
health care needs. To a large extent, the
health care services delivered to women
veterans have grown up in a patchwork
fashion, with the delivery model based in
part on the academic leanings of the women’s
health champion on site. In some facilities,
no particular model was developed and a
default system of heavy utilization of fee
basis care arose. Fortunately, a significant
body of research defining health care provision
models now exists, and this research
provides data on the outcomes associated
with each model.
The face of women veterans is changing.
Even though the greatest proportion of
women veterans seen in VA is from the
Vietnam War era, there is a tremendous
influx of women recently deployed and discharged
from service in OEF/OIF, where
the active duty military is 14 percent female.
Among new military recruits, the proportion
of females is growing, with women comprising
20 percent of the "freshman class."
Cumulative data indicates that 42.2 percent
of all discharged women have utilized VA
health care at least once, and of that group,
45.6 percent have visited from 2 to 10
times.3 While the number of male veterans
is steadily declining, the number of women
veterans is and will continue to be on a pronounced
upward course. Given this trajectory,
the proportion of women veterans
seeking VA health services will likely top 15
percent by 2020.
In FY 2006, the mean age of women veterans
was 49.5 years; this compares with a
mean age for male users of 61 years. However,
it is important to realize that almost
all new women veterans entering VA care
are under age 40, and of childbearing age,
creating a need for a significant shift in provision
of health care. A major project is
underway to involve patients and providers
in counseling about desire for conception,
informed consent, and use of teratogenic
medications. Some classes of medication
that are prescribed frequently to women and
that carry a high birth defect risk include
psychotropics and medications for some
dermatological conditions. In VA, we have
an opportunity to address intentions for becoming
pregnant, utilizing CPRS VISTA
to address veterans' sexual activity and risks,
and to reduce the potential risk of birth defects
from some prescription medications.
Leadership and policy have played an important
role in driving change in care provision
to women veterans. While in earlier
VHA Handbooks provision of gender related
care onsite in VA was mandated, in
the 2003 VHA Handbook 1330.1 genderspecific
care provision was relegated to
"preferred." A decline in onsite offering of
gynecology has occurred in the interim.4 In March 2008, the Under Secretary for
Health, Michael Kussman, M.D., charged a
workgroup to establish women’s health at
every VA, with a consensus definition:
That every women veteran has access to a VA
primary care provider who can meet all her primary
care needs, including gender-specific care, in the
context of an ongoing patient-clinician relationship.
And in July 2008, Secretary Peake and Dr.
Kussman announced that the position of
Women Veterans Program Manager would
be full-time at every facility by December 2008.
The tides have changed, and VA is moving
quickly to implement clinic enhancements
and provision of care that will address the
needs of women veterans. In addition, a
major campaign is underway to involve
every service and every aspect of VA care in
the responsibility to provide the best care
anywhere. The goal is not simply to provide
a model for care of women in the VA, but
to provide a national model for delivery of
comprehensive women’s health care.
Research plays an important role in this
evolution. Not only do sufficient populations
of women veterans now exist for
inclusion in research paradigms, research
is needed to inform specific health care
strategies and models. The time may be
here for additional focused supports for
research on the health of women veterans.
-
Market penetration: current year users divided by
projected living veteran population that year, VetPOP
2003-2007.
-
Bean-Mayberry BA et al. Comprehensive Care for
Women Veterans: Indicators of Dual Use of VA and
Non-VA Providers. Journal of the American Medical
Women's Association 2005; 59(3):192-7.
-
Kang H. OEF/OIF Utilization Data FY 2008
1st Quarter. OPHEH.
-
Seelig, MD et al. Availability of Gynecologic Services
in the Department of Veterans Affairs. Women's Health
Issues 2008; 18(3):167-73.
top
|