Female veterans seeking medical care at Veterans Affairs primary care clinics: psychiatric and medical illness burden and service use

OBJECTIVE

To examine rates of medical and psychiatric disorders among 187 female veterans recruited at four Veterans Affairs Medical Centers (VAMCs), the recognition of such disorders by VAMC care providers, and the use of relevant medical and mental health services by women both within and outside of the VA setting.

METHODS

We used a cross-sectional, epidemiological design incorporating self-report measures, structured interviews, and chart reviews to obtain relevant information for analyses.

RESULTS

Forty-four percent (43.9%) of women met criteria for at least one psychiatric disorder; 34.0% of these women met criteria for two or more additional psychiatric diagnoses, and concordance rates between interview and chart diagnoses were low. Ninety-five percent (95.2%) of women had a medical condition noted in their charts; 86.6% had two or more additional medical conditions, and a significant number of women had both medical and psychiatric diagnoses. Forty-four percent (43.9%) of women with an identified mental health condition received specialized mental health care by the VA in the past year.

CONCLUSIONS

Findings from this study suggest that female veterans treated in VAMCs had significant medical and psychiatric problems, and these women might not be getting their health care needs adequately met through the VA health care system. In light of our findings, we discuss relevant implications and future directions for research.

Changes in service use during a trauma-informed intervention for women

We examined the patterns of services used by women with co-occurring mental health and substance abuse problems with histories of interpersonal violence, and examined the change in patterns of use associated with a targeted intervention as part of the Women, Co-Occurring Disorders, and Violence Study. As hypothesized, we observed that intervention women (n=1023) used more of the main service type that the intervention was focused on providing, outpatient group counseling. The intervention did not have strong effects on patterns of service use external to the intervention, such as emergency room, jail, and shelter use in the first six months of follow-up. The reasons for the stability in patterns of services use are likely complex and imply that the observed increased access to group counseling was not being used as a substitute for other types of services, especially individual counseling, since use of these other services did not decrease during the study period.

Diffusion of innovation in women's health care delivery: the Department of Veterans Affairs' adoption of women's health clinics

BACKGROUND

In response to concerns about the availability and quality of women's health services in Department of Veterans Affairs (VA) medical centers in the early 1990s, Congress approved landmark legislation earmarking funds to enhance women's health services. A portion of the appropriation was used to launch Comprehensive Women's Health Centers as exemplars for the development of VA women's health care throughout the system. We report on the diffusion and characteristics of VA women's health clinics (WHCs) 10 years later.

METHODS

In 2001, we surveyed the senior women's health clinician at each VA medical center serving > or =400 women veterans (83% response rate) regarding their internal organizational characteristics in relation to factors associated with organizational innovation (centralization, complexity, formalization, interconnectedness, organizational slack, size). We evaluated the comparability of WHCs (n = 66) with characteristics of the original comprehensive women's health centers (CWHCs; n = 8).

RESULTS

Gender-specific service availability in WHCs was comparable to that of CWHCs with important exceptions in mental health, mammography and osteoporosis management. WHCs were less likely to have same-gender providers (p < .05), women's health training programs (p < .01), separate women's mental health clinics (p < .001), separate space (p < .05), or adequate privacy (p < .05); however, they were less likely to have experienced educational program closures (p < .001) and staffing losses (p < .05) compared to CWHCs.

CONCLUSIONS

Diffusion of comprehensive women's health care is as yet incomplete. More research is needed to examine the quality of care associated with these models and to establish the business case for managers faced with small female patient caseloads.

Can screening for domestic violence be introduced successfully in a sexual health clinic?

BACKGROUND

Domestic violence is reported frequently when Australian women are surveyed and is associated with poorer health outcomes on a variety of measures. Routine screening for domestic violence is a strategy designed to both prevent domestic violence and provide an opportunity for early intervention.

METHODS

Following staff consultation and training, a 1-month pilot of routine screening for domestic violence (RSDV) of all female patients was conducted in a large sexual health clinic.

RESULTS

Following the evaluation of this pilot, RSDV was introduced in 2003 for all new female patients. Of the 3244 women eligible for screening, 2893 (89%) were screened. Of these, 254 (8.8%) identified domestic violence.

CONCLUSIONS

Routine screening for domestic violence is feasible in a sexual health clinic population. High screening rates were achieved and high rates of domestic violence were identified, providing an opportunity for intervention.

Predicting the timing of women's departure from abusive relationships

The aim of this study was to investigate forces that affect the timing of women's exit from violent relationships with men. Abused women were recruited from posters in the community and battered women's shelters, interviewed, and followed up for 10 years. Data for this study are based on 100 women and were analyzed using event history analysis. Age, ethnicity, and alcohol consumption levels of both partners predicted the timing of women's termination of abusive relationships. An interaction effect showed that women who scored above the mean on an index of physical aggression and who never used shelter services had the longest trajectories of violence exposure; severely abused women without shelter use were more likely to stay. Our findings indicate that women who receive shelter services endure shorter periods of violence than women who do not access such services. Further outreach, especially to women experiencing high rates of physical aggression, is recommended.

Primary And Preventive Healthcare in Obstetrics And Gynecology: A Study of Practice Patterns in The Mid-Atlantic Region

OBJECTIVES

To assess the current perspective of regional obstetrician/gynecologists on providing primary/preventive healthcare, including their desire to provide primary care in their practices and whether or not they are adequately trained as primary care providers.

METHODS

A self-administered survey with a Likert scale that included demographic information and questions about the practice of primary healthcare was mailed to regional obstetrician/gynecologists both in practice and in residency training.

RESULTS

One hundred thirty-nine physicians responded to the survey (33% response rate). Respondents were divided (48% agreed vs. 52% disagreed) when asked if obstetrician/gynecologists should be considered primary healthcare providers. When asked if they viewed themselves as specialists who also provide primary care for women, the majority of physicians (62%) agreed. The majority of physicians (64%) disagreed when asked if they wanted to include primary care in their practice. When asked if they thought that they were adequately trained to provide primary healthcare, respondents were divided (47% agreed vs. 53% disagreed). However, a significant gender difference was found between respondents, with male physicians being more likely than female physicians to agree (55% vs. 33%, p < 0.05) when asked if they were adequately trained to provide primary care.

CONCLUSIONS

In this regional study of obstetrician/gynecologists, physician opinions were divided regarding their status as primary care providers, but the majority of respondents did not want to include primary healthcare in their practice. A significant gender difference exists between physicians with regard to the question of adequate training for primary care, with male obstetrician/gynecologists being more likely as to agree that they are adequately trained to provide primary care.

Health care-based interventions for women who have experienced sexual violence: a review of the literature

Thirty publications that evaluated health care-based interventions for women who experienced sexual violence were reviewed. The findings highlight that clinicians often need training in the provision sexual assault care, and that not all emergency departments have sexual assault care protocols. Studies examining effectiveness found that Sexual Assault Nurse Examiner programs are very helpful, that health care-based sexual assault treatment settings attract more women than do forensic-based settings, that sexual assault survivors often prefer a combination of medication and counseling treatment, and that preexam administration of a video explaining the collection of forensic evidence may reduce women's stress during the procedure. Studies on postexposure HIV prophylaxis found that many women did not complete the treatment regimen, often because of side effects. Emergency contraception to prevent postrape pregnancy is not consistently offered to women. Only one study reported on abortion as part of the range of sexual assault services.

Sexually transmitted diseases in Operation Iraqi Freedom/Operation Enduring Freedom

OBJECTIVE

To identify the incidence of sexually transmitted diseases (STDs) in a female active duty population deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom was the objective of this study.

METHODS

Retrospective chart review was completed on all soldiers seeking outpatient gynecologic care at Camp Doha, Kuwait, from September 2003 through March 2004. Descriptive statistical analysis was performed on data from all patients identified as having an STD.

RESULTS

Forty-four soldiers (2.5% of all encounters) were diagnosed with STDs during the study period. Genital herpes, Condyloma acuminata, and chlamydia were the most commonly identified infections accounting for 30, 25, and 21% of the diagnoses, respectively.

CONCLUSION

Transmission of STDs in the deployed environment continues to be problematic. Viral infections were more commonly encountered than were bacterial infections. Patient education and prevention should be emphasized. Consideration should be given to STD screening upon redeployment.

Health, preventive health care, and health care access among women with disabilities in the 1994–1995 National Health Interview Survey, Supplement on Disability

OBJECTIVES

This study presents national estimates on the health, preventive health care, and health care access of adult women with disabilities. We compared women with 1 or 2 functional limitations (FLs) and > or =3 FLs with women with no FLs. Topics covered included demographic characteristics, selected reported health measures, selected clinical preventive services, and selected access to care indicators and health care coverage.

METHODS

Estimates in this report were based on data from the 1994-1995 National Health Interview Survey, Supplement on Disability (NHIS-D). The sample size for women > or =18 years of age used in producing the estimates from the combined 1994 and 1995 NHIS-D was 77,762.

RESULTS

An estimated 16% of women > or =18 years of age had difficulty with at least 1 FL. Women with FLs were less likely to rate their health as excellent or very good and more likely to report their health as fair or poor when compared with women with no FLs. Women with FLs were also more likely to report being a current smoker, having hypertension, being overweight, and experiencing mental health problems. Among women > or =65 years of age, those with FLs were also less likely to have received Pap smear tests within the past year and those with > or =3 FLs were less likely to have received mammograms within the past year than women with no FLs. Women with > or =3 FLs were more likely to report being unable to get general medical care, dental care, prescription medicines, or eyeglasses, regardless of age group, compared with women with no FLs. The main reasons reported for being unable to receive general care were financial problems or limitations in insurance. These findings suggest that increased attention to the health care needs of women with disabilities from researchers, clinicians, and public health professionals is warranted.

Sexual assault patterns among women with and without disabilities seeking survivor services

INTRODUCTION

The primary research questions were 1) how do sexual assault patterns differ for women with disabilities as compared with women without disabilities and 2) how do patterns differ among women with different disabilities?

METHODS

Study data were derived from initial encounters of 16,672 women survivors of sexual assault who sought state-funded sexual assault survivor services in Massachusetts from 1987 through 1995. Bivariate analyses and fixed effects logistic regression models compared sexual assault patterns including survivor responses for women with and without disabilities and among women with 5 different single disabilities.

RESULTS

More than 10% of survivors reported > or =1 disability. If a woman had a history of a previous assault or was > or =30 at time of assault, she was significantly more likely to report a disability as compared to the referents (no history of assault or <30). Among women with a single disability, a survivor who delayed seeking services > or =6 months was more likely to have a mental health disability. In contrast, a survivor who had a cognitive disability was more likely to report sooner than 6 months compared with a survivor with other single disabilities.

CONCLUSIONS

Differences were found between disabled and nondisabled groups as well as among women with different single disabilities. Some findings, such as those suggesting differential access, may require disability group-specific interventions, whereas other variations can be addressed at the individual client level. State-funded sexual assault survivor service providers may use these findings to improve outreach and service provision strategies.

Addressing Taiwan's high incidence of cervical cancer: factors associated with the Nation's low compliance with Papanicolaou screening in Taiwan

BACKGROUND

Despite cervical cancer being the leading female cancer, women in Taiwan have received fewer screening examinations for this disease than populations in Western countries.

METHODS

Randomly selected telephone questionnaire interviews with women aged 20 years and over were conducted to investigate the factors associated with the subject's cancer screening practices.

RESULTS

Among 1021 respondents, 51.6% self-reported no Papanicolaou (Pap) examination received within their lifetime. The multivariate logistic regression analysis revealed that, in addition to marital status, cancer knowledge was the most significant factor associated with screening practice compliance. Compared with women with correct answers for 22-28 cancer knowledge questions, the odds ratios (OR) for non-compliance were 1.4 (95% confidence interval (CI)=1.0-2.0) for women with 17-21 correct answers and 2.3 (95% CI=1.6-3.4) for women with less than 17 correct answers. Women aged 40-49 years had the best cancer knowledge scores. Unmarried women were at an elevated risk for no Pap examination (OR=7.6, 95% CI=5.2-11.3).

CONCLUSIONS

Women in Taiwan should be targeted for intervention to promote cancer knowledge and screening compliance.

A descriptive study of the decline in cervical screening coverage rates in the North East and Yorkshire and the Humber Regions of the UK from 1995 to 2005

Since the mid-1990s, there has been a steady decline in coverage rates for cervical screening in the target age group (25-64 years) across England. This article describes the rate of decline from 1995 to 2005 in the old health authority areas of the North East and the Yorkshire and the Humber (NEYH) regions in relation to age group, deprivation, ethnicity and religion. The results show that the rate of decline is faster in these northern regions than that in England as a whole, with a very strong correlation between age and rate of change of coverage rates. Younger age groups experience the fastest rate of decline, and those over 55 years show an increase in coverage rates. There is an association between the deprivation of the old health authority areas and the rate of change of coverage rates, with weaker evidence that areas with high proportions of Black or Mixed ethnicity may have a faster decline. However, the rate of decline is not associated with other ethnic groups or religions. Therefore, interventions could be targeted at younger women and those who live in deprived areas to prevent the widening of inequalities.

Counting abortions so that abortion counts: Indicators for monitoring the availability and use of abortion care services

SUMMARY

Maternal mortality reduction has been a focus of major international initiatives for the past two decades. Widespread provision of emergency obstetric care (EmOC) has been shown to be an important strategy for addressing many of the complications that might otherwise lead to maternal death. However, unsafe abortion is one of the major causes of pregnancy-related deaths, and will be only partially addressed by EmOC. This manuscript presents a comprehensive approach to measuring whether abortion-related needs are met.

PROPOSED METHODS

We propose a set of indicators for monitoring the implementation of safe abortion care (SAC) interventions. We build on the model developed for monitoring the availability and use of Emergency Obstetric (EmOC) services. We describe the critical elements ("signal functions") of SAC - including treatment of abortion complications, legal, induced abortion and postabortion contraception - and define the indicators necessary to assess the availability, utilization and quality of abortion-related services.

SAMPLE EVIDENCE

Data from 5 countries suggest there are sufficient service delivery points to provide decentralized abortion care, but that the full range of necessary abortion care services may not be provided at all these sites. Studies from several countries also show that many women receiving services for the treatment of abortion complications accept contraceptive methods when offered prior to discharge. This is an important strategy for reducing unwanted pregnancy, repeat unsafe abortion and risk for abortion-related mortality. Both findings suggest there are considerable opportunities within the present facilities to improve the delivery of abortion care services.

CONCLUSION

This article recommends that the proposed model undergo field-testing on its own or in conjunction with the EmOC indicators, and encourages increased support for this important but often neglected aspect of pregnancy-related health.

HTLV-1 and other viral sexually transmitted infections in antenatal and gynaecological patients in Ghana

BACKGROUND

The study was undertaken to determine the prevalence of infection with Human T cell lymphotrophic (leukemia) virus-1 (HTLV-1), Hepatitis B virus, Hepatitis C virus and Human Immunodeficiency Virus (HIV) in patients attending the antenatal and gynaecological outpatient clinics at Korle-Bu Teaching Hospital (KBTH).

DESIGN

Prospective observational survey. Serum from each of the 517 participants was analysed for infection with Hepatitis B surface antigen with a latex agglutination test kit (Biotech Laboratories Ltd., Suffolk, United Kingdom), and tested for antibodies to Human Immunodeficiency Virus (HIV), Hepatitis C virus, and Human T cell lymphotrophic (leukemia) virus-1 (HTLV-1) with SERODIA passive-particle agglutination assay kits (FUJIREDIO Inc., Tokyo, Japan). The results were compared with reports from other institutions.

SETTINGS

The Obstetrics and Gynaecology outpatient clinics of the Korle-bu Teaching Hospital, Accra, Ghana. The virology Unit of the Noguchi Memorial Institute for Medical Research (NMIMR), Accra, Ghana.

RESULTS

The prevalence of infection with Hepatitis B surface antigen (HBsAg) was 16.8%, Hepatitis C antibody 5.2% and HTLV-1 2.7%. Twelve (6%) out of 199 participants who gave informed consent tested positive for HIV antibody.

CONCLUSIONS

The study has demonstrated a high transmissible risk of HBV, HIV, HTLV-1, and HCV in Ghana and the necessity for antenatal screening for HBsAg to identify babies at risk of neonatal hepatitis B infection for appropriate intervention.

VA emergency health care for women: condition--critical or stable?

BACKGROUND

Veteran's Affairs (VA) facilities have reconfigured themselves to address the health care needs of the growing number of women veterans. However, the challenge of providing comprehensive care to a group that is an extreme minority within VA may still leave gaps in the delivery of necessary health care services.

OBJECTIVES AND METHODS

We sought to assess the availability of women's health care specialists for emergency gynecologic problems (emergency-GYN) and for emergency mental health conditions specific to women (emergency-WMH), we surveyed the Chief of Staff and senior clinician at each VA site serving 400 or more women veterans.

RESULTS

Emergency-GYN expertise was usually available at all times for 39.8% of sites, and only during usual clinic hours for 24.6% of sites. An emergency-WMH specialist was available at all times for 51.7% of sites, and only during usual clinic hours for 31.0% of sites. VA sites that had a separate women's health clinic were more likely to have emergency-GYN expertise available. Sites in regions with higher managed care penetration were less likely to have emergency-WMH specialist availability.

CONCLUSIONS

Our data suggest a limited availability of specialists for gynecologic and women's mental health emergencies at some VA sites. How this may affect overall quality of care for women in the VA system is unknown. Further work is needed to determine actions clinicians take when expertise is emergently needed for health care issues unique to women. Options for expanding VA availability of such expertise include internal development of women's health expertise and telemedicine access to experts to aid in emergency women's health care decision making.

Insurance coverage and health care use among near-elderly women

OBJECTIVES

Data on near-elderly (ages 55-64) women's access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women's health insurance coverage in the United States and how it may influence their use of health care services.

METHODS

A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women's use of outpatient services, inpatient services, and prescription medication over a 2-year period.

RESULTS

In 2002, 9.4% of near-elderly women in the United States were uninsured and 15.4% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost.

CONCLUSIONS

The nature of a near-elderly woman's insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage.

Provision of contraceptive and related services by publicly funded family planning clinics, 2003

CONTEXT

In addition to contraceptive services, publicly funded family planning clinics provide low-income women with a range of reproductive diagnostic, treatment and educational services. Nationally representative information about the scope of services available from clinics is needed to formulate policy and programmatic recommendations.

METHODS

In 2003, more than 1,000 U.S. clinics responded to an eight-page survey on service availability and clinic policies. Differences in the proportions of clinics reporting each service or policy were examined by clinic type and receipt of Title X funding.

RESULTS

Nearly all clinics offer pills, injectables and condoms; 75% offer the patch; and 80% offer emergency contraception. Most clinics (73%) typically use a conventional Pap smear for initial cervical cancer screenings; 27% use liquid-based Pap tests. For follow-up, 68% of clinics use liquid-based or other advanced testing. Virtually all clinics screen at least some clients for chlamydia; Planned Parenthood and Title X-funded clinics, more than others, tend to focus screening efforts on sexually active women aged 25 and younger. Single-dose treatments are provided by 58% of clinics. Nine in 10 clinics offer HIV testing on-site, most of them to any client who requests it. Services targeted to specific populations include counseling about abstinence for minors (91%); non-reproductive health services for men (36%); and availability of staff such as translators (81%) and bilingual administrative (59%) or clinical personnel (57%) for non-English-speaking clients.

CONCLUSIONS

More public funding is imperative for clinics to keep up with the demands of new technologies and a diverse client base.

Is antenatal care effective in improving maternal health in rural uttar pradesh? Evidence from a district level household survey

Data from the District Level Household Survey (2002) conducted by the Reproductive and Child Health Project in India has been used to examine the impact of utilization of antenatal care services on improvement in maternal health in rural areas of Uttar Pradesh, India. Multilevel analysis shows that after controlling for other socioeconomic and demographic factors, utilization of antenatal care services may lead to the utilization of other maternal health related services such as institutional delivery, delivery assisted by trained professionals, seeking advice for pregnancy complications, and seeking advice for post-delivery complications. There is strong clustering of utilization of services within the primary sampling units (i.e. villages) and districts.

Seroprevalence and correlates of herpes simplex virus type-2 infection in a general gynecology clinic

BACKGROUND

Up to two-thirds of individuals acquire herpes asymptomatically and most infected persons shed the virus during latency periods. Genital infection is frequently associated with the presence of other sexually transmitted diseases. The objective of this paper was to assess the seroprevalence of HSV-2 in a low risk population and to validate the use of reported symptoms and clinical signs as a possible diagnostic tool to screen for HSV-2.

METHODS

One hundred and fifty consecutive women presenting for the first time to the Gynecology outpatient clinic with complaints of vaginal discharge, lower abdominal pain, genital warts or ulcers were enrolled over a period of 4 months. Samples were taken and laboratory tests were performed to evaluate the presence of common reproductive tract infections including HSV-2.

RESULTS

In this study, using a validated type specific assay, we found an unexpected high prevalence of HSV-2 (35 subjects, 23.3%). Of the 147 women who presented with the symptom of vaginal discharge, 34 (23.1%) tested positive for HSV-2. On examination cervical erosion and tenderness was noted in 50 women, in 23 (46%) of whom HSV-2 tested positive. On univariate analysis, no significant association was found between selected demographic factors, STIs and NSTIs and HSV-2. The association between previous abortion and HSV-2 was however, statistically significant. Also, none of the women who had HSV-2 positivity tested positive for HIV.

CONCLUSION

The high HSV-2 seroprevalence in this low risk population may indicate a high risk for future acquisition of HIV in this population. Cervical erosion and hypertrophy as a possible clinical marker for HSV-2 has low positive predictive value and cannot be recommended as a possible diagnostic tool to screen for HSV-2 in resource poor settings.

Health Counseling for Women in the Absence of Financial Barriers: Comparing Reported Counseling Rates of Women in the United States and Israel

This study compares rates of health counseling for women in the United States and Israel and identifies factors affecting counseling rates, based on a weighted sample of 2,257 US and 848 Israeli women. In both countries, fewer than half of the women reported speaking with a physician about any of a set of preventive counseling topics (e.g., smoking, diet, exercise) during the year preceding the survey. However, US women reported significantly higher rates of health counseling than did Israeli women, even among specific risk groups (e.g., smokers). Multivariate analysis revealed that "country" had an independent effect after controlling for demographic factors. This paper highlights structural and functional barriers to counseling that persist in the Israeli system in the absence of financial barriers and discusses ways to overcome them.

Factors Associated with Use of Hormone Therapy Among Women with Mobility Impairments

The purpose of the study was to examine the factors associated with hormone therapy (HT) use among women with mobility impairments. A non-probability sample of 188 menopausal women (average age = 53 years) from 38 states was recruited in 2004 for the study. Twenty-two percent of participants were currently taking HT; 33% were past users. Using multinomial logistic regression, this study found that those most likely to be taking HT now or in the past were older women, knowledgeable about HT, had had a hysterectomy, had bone loss, and had their provider's encouragement. Implications for health care providers are discussed.

Disease prevalence and use of preventive services: comparison of female veterans in general and those with spinal cord injuries and disorders

BACKGROUND

Disease prevalence and use of preventive services may differ between women veterans in general and those with spinal cord injuries and disorders (SCI&D). Prevention is particularly important in SCI&D, and disparities may exist in receipt of this care, particularly when special equipment and body adjustments are needed, among women with SCI&D.

METHODS

To compare disease prevalence and preventive service use among female veterans in general and those with SCI&D, we conducted a cross-sectional survey among female veterans in general (n = 478) and those with SCI&D (n = 115). Behavioral Risk Factor Surveillance System (BRFSS) survey questions were administered to veterans with SCI&D and compared with 2003 CDC BRFSS data.

RESULTS

Female veterans with SCI&D were similar in age and race but were better educated and less likely to be employed than female veterans in general. Coronary heart disease (CHD) prevalence was higher in those with SCI&D (17% vs. 8%, p < 0.0001). Health status was lower in SCI&D (27%) than in general female veterans (41%), p = 0.002. Fewer women with SCI&D, than female veterans in general reported having received recommended dental care (56% vs. 69%, p = 0.004), colon screening in prior 5 years (59% vs. 72%, p = 0.023) or prior 10 years (67% vs. 92%, p< 0.0001), mammogram (84% vs. 91%, p = 0.019), and Pap smear (88% vs. 98%, p < 0.0001). There were no differences in receipt of respiratory vaccinations or cholesterol screening.

CONCLUSIONS

Receipt of services that require the use of equipment, body adjustments, and potential discomfort due to disability was lower in women with SCI&D. Veterans Affairs (VA) is doing well in most areas, but there are gaps in receipt of some preventive services. Efforts to increase preventive care in women with SCI&D should address equipment and access barriers and patient and provider education.

A comprehensive women's health care center: are gynecologists offering primary care?

OBJECTIVE

The purpose of this study was to compare patient characteristics and diagnoses in a comprehensive Women's Health Care Clinic between gynecologists and internal medicine physicians.

STUDY DESIGN

This retrospective cohort study evaluated International Classification of Diseases, 9th Revision, codes that were recorded between January 1, 2001, and January 4, 2004, at the Women's Health Care Clinic. We compared demographics and prevalence of diagnosis codes for patients who were seen by obstetricians/gynecologists and internal medicine physicians and compared these data with national survey statistics. A sampling of charts was reviewed for coding verification.

RESULTS

We analyzed 13,462 visits at the Women's Health Care Clinic. Patients who were seen by internists were older, had greater racial diversity, and had more gender-nonspecific medical disorders (hypertension, depression). Gynecologists saw more specific women's health problems (P < .05). The diagnoses of menstrual disorders, menopause, pelvic pain, and abnormal cytologic findings within the Women's Health Care Clinic follow closely with the national ambulatory survey data.

CONCLUSION

Within this multispecialty Women's Health Care Clinic, internal medicine physicians are practicing primary care and obstetricians/gynecologists are providing specialty care.