title: Health and Health Care Access of Rural Women Veterans: Findings From the National Survey of Women Veterans.
abstract: Disparities in health and health care access between rural and urban Americans are well documented. There is evidence that these disparities are mirrored within the US veteran population. However, there are few studies assessing this issue among women veterans (WVs).
  
  
  
  Using the 2008-2009 National Survey of Women Veterans, a population-based cross-sectional national telephone survey, we examined rural WVs' health and health care access compared to urban WVs. We measured health using the Medical Outcomes Study Short-Form (SF-12); access using measures of regular source of care (RSOC), health care utilization, and unmet needs; and barriers to getting needed care.
  
  
  
  Rural WVs have significantly worse physical health functioning compared to urban WVs (mean physical component score of 43.6 for rural WVs versus 47.2 for urban WVs; P = .007). Rural WVs were more likely to have a VA RSOC (16.4% versus 10.6%; P = .009) and use VA health care (21.7% versus 12.9%; P < .001), and had fewer non-VA health care visits compared with urban WVs (mean 4.2 versus 5.9; P = .021). They had similar overall numbers of health care visits (mean 5.8 versus 7.1; P = .11 ). Access barriers were affordability for rural WVs and work release time for urban WVs. Rural WVs additionally reported that transportation was a major factor affecting health care decisions.
  
  
  
  Our findings demonstrate VA's crucial role in addressing disparities in health and health care access for rural WVs. As VA continues to strive to optimally meet the needs of all WVs, innovative care models need to account for their high health care needs and persistent barriers to care.
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California. kristina.cordasco@va.gov.|Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California. kristina.cordasco@va.gov.|Department of Medicine, University of California Geffen School of Medicine, Los Angeles, California. kristina.cordasco@va.gov.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Cordasco
authors.affiliation: VA Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City, Iowa.|Veterans Rural Health Resource Center - Iowa City, Iowa City, Iowa.|Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mengeling
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, 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
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California.|Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.|Department of Medicine, University of California Geffen School of Medicine, Los Angeles, California.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D016387:Women's Health / Q000706:statistics & numerical data*
keywords: access to care; health-related quality of life; utilization of health services; veterans; women