Bergman Alicia A, Frankel Richard M, Hamilton Alison B, Yano Elizabeth M
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.
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.
Womens Health Issues. 2015 Jan-Feb;25(1):28-34. doi: 10.1016/j.whi.2014.10.004.
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.
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.
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.
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.
退伍军人事务部（VA）机构中女性退伍军人的数量不断增加，这促使人们需要更加关注与女性健康（WH）初级保健需求相关的临床专业能力。现在，一种全面的初级保健模式取代了为多次就诊预约或转诊患者到女性健康诊所或其他特定性别护理场所的做法，该模式允许女性退伍军人患者由接受过女性健康培训/有相关经验的初级保健提供者（PCP）诊治，这些提供者能够在一次就诊中同时为患者提供初级保健和女性健康护理。然而，目前对于女性健康初级保健提供者在采用这种方法将特定性别的服务纳入女性退伍军人初级保健服务时所面临的障碍和促进因素知之甚少。
我们对一家中西部退伍军人事务部医疗中心的22名女性健康初级保健提供者进行了定性深入访谈。所有参与者都是主医疗中心内四个门诊初级保健诊所之一、一个校外卫星诊所或两个校外社区门诊诊所的成员。
归纳主题分析确定了六个主题：1）时间限制，2）工作人员支持的重要性，3）充足空间和设备/用品的必要性，4）有创伤史患者的不适感，5）缺乏教育/培训，6）排班/后勤方面的挑战。
虽然充足的工作人员是一个关键促进因素，但研究结果表明可能存在一些障碍，削弱了退伍军人事务部女性健康初级保健提供者提供高质量、全面的初级保健和特定性别的护理的能力。这些障碍的性质是多因素和多层次的，因此可能需要采取特殊的政策和实践行动。
