The Focus They Deserve: Improving Women Veterans' Health Care Access
The Focus They Deserve: Improving Women Veterans' Health Care Access
复制标题
DOI：
10.1016/j.whi.2020.12.011
复制
发表时间：
2021-06-30
影响因子：
3.2
通讯作者：
Sayre, George
中科院分区：
文献类型：
--
作者：
Marshall, Vanessa;Stryczek, Krysttel C.;Sayre, George
目的：退伍军人健康管理局（VHA）的举措旨在为退伍军人提供及时获得优质医疗保健。这项分析的重点是提供者和工作人员的角度来看，在国家努力提高退伍军人的访问到care.Methods：我们完成了21个退伍军人健康管理局医疗设施的现场访问，以评估国家访问倡议的实施。定性数据收集包括半结构化访谈（n = 127），焦点小组（n = 81），并与当地领导，管理人员，供应商和支持人员在每个设施的初级和专科护理服务的意见。演绎和归纳的内容分析，以确定障碍，促进者，和上下文因素影响实施的举措和女退伍军人的access.Results：与会者确定的障碍，女退伍军人的访问和战略，以提高访问。障碍包括在妇女保健和针对性别的保健服务方面受过培训的提供者有限（例如，妇女专科护理）、与社区提供者的转诊和协调效率低下，以及心理社会因素（例如，儿童保育）。与会者还确定了与儿童保育有关的问题和医疗设施中的骚扰问题，作为退伍军人妇女的独特准入问题。战略的重点是提高内部能力，通过简化提供者培训和资格认证、与提供者签订合同、利用远程保健以及改善社区提供者的服务来填补妇女服务方面的空白，从而为妇女提供现场综合护理和专业服务。与会者还强调了努力提高性别敏感的护理delivery.Conclusions：虽然有些问题影响到所有退伍军人，社区护理转介的问题可能会不成比例地影响女性退伍军人的访问，由于一系列的性别特定的服务对社区护理的必要依赖。爱思唯尔公司出版代表雅各布妇女健康研究所。
Purpose: Veterans Health Administration (VHA) initiatives aim to provide veterans timely access to quality health care. The focus of this analysis was provider and staff perspectives on women veterans' access in the context of national efforts to improve veterans' access to care.Methods: We completed 21 site visits at Veterans Health Administration medical facilities to evaluate the implementation of a national access initiative. Qualitative data collection included semistructured interviews (n = 127), focus groups (n = 81), and observations with local leadership, administrators, providers, and support staff across primary and specialty care services at each facility. Deductive and inductive content analysis was used to identify barriers, facilitators, and contextual factors affecting implementation of initiatives and women veterans' access.Results: Participants identified barriers to women veterans' access and strategies used to improve access. Barriers included a limited availability of providers trained in women's health and gender-specific care services (e.g., women's specialty care), inefficient referral and coordination with community providers, and psychosocial factors (e.g., childcare). Participants also identified issues related to childcare and perceived harassment in medical facility settings as distinct access issues for women veterans. Strategies focused on increasing internal capacity to provide on-site women's comprehensive care and specialty services by streamlining provider training and credentialing, contracting providers, using telehealth, and improving access to community providers to fill gaps in women's services. Participants also highlighted efforts to improve gender-sensitive care delivery.Conclusions: Although some issues affect all veterans, problems with community care referrals may disproportionately affect women veterans' access owing to a necessary reliance on community care for a range of gender-specific services. Published by Elsevier Inc. on behalf of Jacobs Institute ofWomen's Health.