title: VA emergency health care for women: condition--critical or stable?
abstract: BACKGROUND
  Veteran's Affairs (VA) facilities have reconfigured themselves to address the health care needs of the growing number of women veterans. However, the challenge of providing comprehensive care to a group that is an extreme minority within VA may still leave gaps in the delivery of necessary health care services.
  
  
  OBJECTIVE
  We sought to assess the availability of women's health care specialists for emergency gynecologic problems (emergency-GYN) and for emergency mental health conditions specific to women (emergency-WMH), we surveyed the Chief of Staff and senior clinician at each VA site serving 400 or more women veterans.
  
  
  RESULTS
  Emergency-GYN expertise was usually available at all times for 39.8% of sites, and only during usual clinic hours for 24.6% of sites. An emergency-WMH specialist was available at all times for 51.7% of sites, and only during usual clinic hours for 31.0% of sites. VA sites that had a separate women's health clinic were more likely to have emergency-GYN expertise available. Sites in regions with higher managed care penetration were less likely to have emergency-WMH specialist availability.
  
  
  CONCLUSIONS
  Our data suggest a limited availability of specialists for gynecologic and women's mental health emergencies at some VA sites. How this may affect overall quality of care for women in the VA system is unknown. Further work is needed to determine actions clinicians take when expertise is emergently needed for health care issues unique to women. Options for expanding VA availability of such expertise include internal development of women's health expertise and telemedicine access to experts to aid in emergency women's health care decision making.
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA. donna.washington@va.gov
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Caroline
authors.initials: C
authors.lastname: Goldzweig
authors.forename: Barbara
authors.initials: B
authors.lastname: Simon
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D005831:Genital Diseases, Female / Q000628:therapy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D016387:Women's Health; D014932:Women's Health Services / Q000706:statistics & numerical data