Meredith Lisa S, Wang Yan, Okunogbe Adeyemi, Bergman Alicia A, Canelo Ismelda A, Darling Jill E, Yano Elizabeth M
RAND Corporation, Santa Monica, California; VA HSR&D Center for Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.
RAND Corporation, Santa Monica, California; Pardee RAND Graduate School, Santa Monica, California.
Womens Health Issues. 2017 Mar-Apr;27(2):221-227. doi: 10.1016/j.whi.2016.11.008. Epub 2017 Jan 10.
Despite the growing demand for health care among women veterans in the Veterans Health Administration (VHA), little is known about the perspectives of primary care providers (PCPs) and other primary care staff about the care they provide to women veterans. We sought to understand whether barriers to, attitudes about, and practices in caring for women veterans were associated with two measures of implementation of the VHA patient-centered medical home for women veterans (self-efficacy and satisfaction).
We administered a cross-sectional survey by Internet from September 8, 2014, through April 27, 2015 (and by mail from December 16, 2014, through June 18, 2015) to all PCPs and affiliated primary care staff in 12 VHA medical centers. We used descriptive and bivariate analyses to characterize their barriers, attitudes, and practices regarding care for women veterans; and ordinary least squares regression to identify associations with satisfaction and self-efficacy regarding medical home implementation for women veterans among members of a VHA patient-centered medical home teamlet for women patients.
Of 775 surveys sent, 288 were completed (94 PCPs and 194 staff) for a response rate of 37% (33% for PCPs; 39% for staff). On average, providers had one female patient for every five patients in their panels. Lower perceived barriers, higher gender-sensitive attitudes, and being a PCP were significantly associated with satisfaction and self-efficacy of patient-centered medical home for women patients.
Training efforts focused on eliminating perceived barriers and strengthening positive attitudes toward women may be more successful than changing women's health practice characteristics alone.
尽管退伍军人健康管理局（VHA）中女性退伍军人对医疗保健的需求不断增长，但对于初级保健提供者（PCP）和其他初级保健工作人员对女性退伍军人提供的护理的看法却知之甚少。我们试图了解照顾女性退伍军人的障碍、态度和做法是否与VHA以患者为中心的女性退伍军人医疗之家的两项实施指标（自我效能感和满意度）相关。
我们于2014年9月8日至2015年4月27日通过互联网（并于2014年12月16日至2015年6月18日通过邮寄）对12个VHA医疗中心的所有初级保健提供者和附属初级保健工作人员进行了横断面调查。我们使用描述性和双变量分析来描述他们对女性退伍军人护理的障碍、态度和做法；并使用普通最小二乘法回归来确定与VHA以患者为中心的女性患者医疗之家团队成员中女性退伍军人医疗之家实施的满意度和自我效能感的关联。
在发送的775份调查问卷中，有288份完成（94名初级保健提供者和194名工作人员），回复率为37%（初级保健提供者为33%；工作人员为39%）。平均而言，提供者的患者小组中每五名患者中有一名女性患者。较低的感知障碍、较高的性别敏感态度以及作为初级保健提供者与女性患者以患者为中心的医疗之家的满意度和自我效能感显著相关。
专注于消除感知障碍和强化对女性积极态度的培训努力可能比仅改变女性健康实践特征更成功。
