Reproductive Healthcare Provision in the Veterans Healthcare Administration: A Mixed Methods Evaluation [20F

Abstract

INTRODUCTION: Despite efforts to prioritize comprehensive care for women Veterans within the Veterans Health Administration (VHA), disparities in reproductive health services exist, especially for those accessing care in rural VHA community-based outpatient clinics (CBOCs). We sought to understand barriers and facilitators to VHA reproductive health service provision, including in rural settings. METHODS: We performed a mixed methods study, including a quantitative survey and semi-structured, qualitative interviews. We recruited women’s health primary care providers and support staff from the Salt Lake City medical center and 8 surrounding CBOCs. We employed a Likert scale to assess comfort with 17 reproductive health services and performed descriptive analyses. In qualitative interviews, we explored provider/staff training, current care processes, and improvement opportunities. We audio-recorded, transcribed, and used Crabtree and Mill’s Editing Approach to identify dominant themes. RESULTS: We recruited 15 participants across 9 sites (4 physicians, 7 nurse practitioners and 4 registered nurses). Mean age was 49.6 years, 86.7% were women, and 93.3% were white. Comfort scores were lowest for fertility counseling and intrauterine device or implant management. In qualitative analyses, barriers included inability to attain/maintain proficiency, staff turnover, inability to order or maintain supplies, referral challenges, and lack of Veteran awareness of available services. We identified few facilitators, including reproductive health experience outside the VHA, invested support staff, and care coordination relationships at the VHA medical center or in the community. CONCLUSION: Addressing barriers to VHA reproductive healthcare provision is needed to overcome disparities related to clinic location and to improve reproductive health outcomes for all women Veterans.