Determinants of contraceptive availability at medical facilities in the department of veterans affairs

Abstract

VA's provision of hormonal and intrauterine contraception is in accordance with community standards, although onsite availability is not universal. Although contraception is a crucial component of a woman's health maintenance, her ability to obtain certain contraceptives from the facility where she obtains her primary care is largely influenced by the availability of a gynecologist. Further research is needed to determine how fragmentation of women's care into reproductive and nonreproductive services impacts access to contraception and the incidence of unintended pregnancy.

Effect of Health-Related Quality of Life on Women and Men’s Veterans Affairs (VA) Health Care Utilization and Mortality

“…The apparent gender difference might also be explained if younger, poorer functioning women veterans who received care outside the Twin Cities supplemented or substituted non-VA primary care for VA primary care more than their male counterparts did. For example, as hospital-based VA clinics (as would be found at the Twin Cities' Minneapolis VA Medical Center) tend to offer a higher range of gynecological and contraceptive services than clinic-based VA sites, 32 younger women receiving care outside the Twin Cities may have elected to obtain primary and gynecological care from a single, non-VA source to avoid fragmented care. Our data would not have captured this phenomenon.…”

The Role of Organizational Factors in the Provision of Comprehensive Women's Health in the Veterans Health Administration

“…Previous studies have indicated that a gynecology clinic is associated with more advanced gynecologic services like intra-uterine device placement, though hormonal contraception, which can be prescribed by a primary care provider, was widely available as in our study. 21,22 In fact, none of the organizational factors studied were significantly associated with availability of services, indicating the role of a WHC in providing these services merits further study.…”

“…21,22 We are the first to examine a package of services that would better promote "one stop shopping" for women veterans, reducing the number of providers and visits. Sites with a WHC or WHC/DWHP were over three times as likely to provide a bundle of basic gynecology services as compared to site with no specific model of women's health care in primary care.…”

“…20 In addition, greater women's health autonomy in staffing decisions, an urban, hospital-based clinical setting and an academic affiliation have also been associated with advanced gynecologic services. [20][21][22] In this study, we examine organizational factors associated with adoption of models of women's health care in the VHA using the Greenhalgh model of Diffusion of Innovations in Service Organizations. 23 We also examine the relationship of model of care to availability of basic gynecologic services in primary care, adjusting for organizational factors.…”

Unintended Pregnancy and Contraceptive Use Among Women Veterans: The ECUUN Study

“…All prescriptions, including contraceptive prescriptions, have a fixed co-pay of $9 and no co-pays for Veterans for five years after discharge from service in Afghanistan or Iraq or who are disabled by an injury or illness that was incurred during active military service (i.e., service-connection); contraceptive devices are provided at no cost. 16,17 Thus, women VA-users have access to the full range of contraceptive methods (although provision for some methods may not necessarily be on site 18,19 ). Nonetheless, it remains unclear to what degree their contraceptive needs are being met, as there are no studies that comprehensively assess use of contraception or unintended pregnancy in the VA population.…”