title: Challenges with delivering gender-specific and comprehensive primary care to women veterans.
abstract: BACKGROUND
  The growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services.
  
  
  METHODS
  We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics.
  
  
  RESULTS
  Inductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics.
  
  
  CONCLUSIONS
  Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action.
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California. Electronic address: alicia.bergman@va.gov.
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Bergman
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
authors.affiliation: Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Hamilton
authors.affiliation: Center for the Study of Healthcare Innovation, Implementation & Policy, Health Services Research and Development Service CIN 13-417, VA Greater Los Angeles Healthcare System, North Hills, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D003191:Comprehensive Health Care / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D007196:Indiana; D007407:Interviews as Topic; D008297:Male; D010465:Perception; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012017:Referral and Consultation; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D016387:Women's Health