, Volume 21, Issue 3 Supplement, pp S11-S18
Date: 10 May 2014

To use or not to use

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Abstract

BACKGROUND AND OBJECTIVE: Effects of advances in Department of Veterans Affairs (VA) women’s health care on women veterans’ health care decision making are unknown. Our objective was to determine why women veterans use or do not use VA health care.

DESIGN AND PARTICIPANTS: Cross-sectional survey of 2,174 women veteran VA users and VA-eligible nonusers throughout southern California and southern Nevada.

MEASUREMENTS: VA utilization, attitudes toward care, and socio-demographics.

RESULTS: Reasons cited for VA use included affordability (67.9%); women’s health clinic (WHC) availability (58.8%); quality of care (54.8%); and convenience (47.9%). Reasons for choosing health care in non-VA settings included having insurance (71.0%); greater convenience of non-VA care (66.9%); lack of knowledge of VA eligibility and services (48.5%); and perceived better non-VA quality (34.5%). After adjustment for sociodemographics, health characteristics, and VA priority group, knowledge deficits about VA eligibility and services and perceived worse VA care quality predicted outside health care use. VA users were less likely than non-VA users to have after-hours access to nonemergency care, but more likely to receive both general and gender-related care from the same clinic or provider, to use a WHC for gender-related care, and to consider WHC availability very important.

CONCLUSIONS: Lack of information about VA, perceptions of VA quality, and inconvenience of VA care, are deterrents to VA use for many women veterans. VA WHCs may foster VA use. Educational campaigns are needed to fill the knowledge gap regarding women veterans’ VA eligibility and advances in VA quality of care, while VA managers consider solutions to after-hours access barriers.

The author have no conflict of interest to declare.
This study was funded by the Department of Veterans Affairs, Health Services Research and Development Service (#GEN-00-082). Dr. Washington is supported by an Advanced Research Career Development Award from the Veterans Affairs Health Services Research and Development Service (#RCD-00-017). The authors gratefully acknowledge Mark Canning for overall project management, Barbara Sasso for assistance with survey development, Martin Lee, PhD, for statistical assistance, and the site principal investigators Leslie Satz, MSN, ANP, Stuart Gilman, MD, MPH, Nancy McNulty, MSN, ANP, and Denise Bartlett-Chekal, MSN, FNP. We also thank James Strike and Rick Paulson of the VA Austin Automation Center and Patricia Murphy of the VA Information Resource Center (VIReC) for assistance with sample development, and California Survey Research Services Inc. for survey fieldwork. The views expressed within are solely those of the authors, and do not necessarily represent the views of the Department of Veterans Affairs.