Women Veterans' Pathways to and Perspectives on Veterans Affairs Health Care.
BACKGROUND
We examined Veterans Affairs (VA) health care experiences among contemporary women veteran patients receiving care at a VA medical center. Specifically, we examined women veteran patients' satisfaction with VA care along dimensions in line with patient-centered medical home (patient-aligned care teams [PACT] in VA) priorities, and pathways through which women initially accessed VA care.


METHODS
We used a mixed methods research design. First, 249 racially diverse women (ages 22-64) who were past-year users of primary care at a VA medical center completed interviewer-administered surveys in 2012 assessing ratings of satisfaction with care in the past year. We then conducted in-depth qualitative interviews of a subset of women surveyed (n = 25) to gain a deeper understanding of perspectives and experiences that shaped satisfaction with care and to explore women's initial pathways to VA care.


RESULTS
Ratings of satisfaction with VA care were generally high, with some variation by demographic characteristics. Qualitative interviews revealed perceptions of care centered on the following themes: 1) barriers to care delay needed medical care, while innovative care models facilitate access, 2) women value communication and coordination of care, and 3) personalized context of VA care, including gender sensitive care shapes women's perceptions. Pathways to VA care were characterized by initial delays, often attributable to lack of knowledge or negative perceptions of VA care. Informal social networks were instrumental in helping women to overcome barriers.


CONCLUSIONS
Findings highlight convergence of women's preferences with PACT priorities of timely access to care, provider communication, and coordination of care, and suggest areas for improvement. Outreach is needed to address gaps in knowledge and negative perceptions. Initiatives to enhance women veterans' social networks may provide an information-sharing resource.
Center for Health Equity Research and Promotion (CHERP), Philadelphia VA Medical Center, Philadelphia, Pennsylvania. Electronic address: Clara.Wagner@va.gov.
Clara
C
Wagner
Center for Health Equity Research and Promotion (CHERP), Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
Melissa E
ME
Dichter
VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Quantitative Health Sciences & Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.
Kristin
K
Mattocks
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D010465:Perception; D036301:Qualitative Research; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D016387:Women's Health; D055815:Young Adult