title: Comprehensive care for women veterans: indicators of dual use of VA and non-VA providers.
abstract: OBJECTIVE
  To compare women who use Department of Veterans Affairs (VA) health care providers only with women who use VA and non-VA providers (dual users).
  
  
  METHODS
  An anonymous survey was mailed to women veterans randomly sampled from 10 VA medical centers in 3 states. We measured reports of dual use of VA and non-VA providers according to the VA provider's gender, provision of routine gynecological care by VA provider, use of VA women's clinic, and overall satisfaction with VA care. Multiple logistic regression analyses were performed with adjustment for patient demographics, health status, VA service connection status, and clustering by site to determine what factors influenced dual use of providers.
  
  
  RESULTS
  In the fully adjusted logistic regression model, provision of routine gynecological care by VA providers (odds ratios [OR] 0.37; 95% confidence intervals [CI] 0.22, 0.60) and use of VA women's clinics (OR 0.56; CI 0.35, 0.90) were strongly associated with a lower likelihood of dual use. Dissatisfaction with care (OR 1.88; CI 1.04,3.41) and higher income (OR 1.89; CI 1.32, 2.71) were also associated with an increased likelihood of dual use. Having a female VA provider was not associated with dual use.
  
  
  CONCLUSIONS
  Women veterans' use of VA and non-VA providers is influenced by the scope of clinical services and dissatisfaction with those services. VA clinics should either promote routine gynecological care within primary care clinic settings or pair traditional primary care with VA women's clinics to enhance coordination and comprehensiveness and, thus, reduce fragmentation of care for veteran women.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, USA.
authors.forename: Bevanne
authors.initials: B
authors.lastname: Bean-Mayberry
authors.forename: Chung-Chou
authors.initials: CC
authors.lastname: Chang
authors.forename: Melissa
authors.initials: M
authors.lastname: McNeil
authors.forename: Patricia
authors.initials: P
authors.lastname: Hayes
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003691:Delaware; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010414:Pennsylvania; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014600:Utilization Review / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology*; D014903:West Virginia; D014930:Women / Q000523:psychology*; D014932:Women's Health Services / Q000592:standards / Q000706:statistics & numerical data*