INTRODUCTION
METHODS
Study Design
Data Source
Study Variables
Statistical Analysis
RESULTS
Site Characteristics
Total | Metropolitan hospital | Non-metropolitan hospital | Metropolitan CBOC | |
---|---|---|---|---|
n
| 193 | 106 | 23 | 64 |
Practice context
| ||||
Region n (%) | ||||
Northeast | 30 (16) | 23 (22) | 2 (9) | 5 (8) |
Midwest | 44 (23) | 25 (24) | 8 (35) | 11 (17) |
South | 73 (38) | 38 (36) | 7 (30) | 28 (43) |
West | 46 (24) | 20 (19) | 6 (26) | 20 (31) |
Organization of the practice
| ||||
≥ 1,209 women Veterans in 2006a
| 97 (51) | 77 (73) | 7 (30) | 13 (21) |
Women’s health clinic for primary care n (%) | 130 (67) | 84 (79) | 16 (70) | 30 (47) |
Gynecology clinic n (%) | 85 (44) | 59 (56) | 8 (35) | 18 (28) |
Women’s health resources: always or usually sufficient n (%)a
| ||||
Clinical expertise | 160 (84) | 88 (85) | 20 (87) | 52 (83) |
Same gender providers | 154 (82) | 90 (86) | 17 (77) | 47 (76) |
Nursing staff | 142 (74) | 78 (74) | 17 (74) | 47 (75) |
Administrative and support staff | 108 (57) | 60 (57) | 10 (44) | 38 (60) |
Clinic space | 125 (66) | 68 (65) | 18 (78) | 39 (63) |
Properly equipped examination rooms | 183 (96) | 101 (97) | 22 (96) | 60 (95) |
Female attendants | 163 (86) | 91 (88) | 22 (96) | 50 (79) |
Budget or funding | 73 (46) | 42 (47) | 8 (42) | 23 (46) |
Formal women’s health training n (%) | 16 (8) | 12 (12) | 0 | 4 (6) |
Separate budget or control point n (%) | 32 (17) | 25 (24) | 3 (13) | 4 (7) |
Change in women’s health resources over the last 2 years n (%) | ||||
Increased | 62 (33) | 10 (39) | 7 (31) | 15 (24) |
Unchanged | 102 (54) | 47 (45) | 12 (52) | 43 (68) |
Decreased | 26 (13) | 17 (16) | 4 (17) | 5 (8) |
On-Site Availability of Reproductive Health Services
Total | Metropolitan hospital | Non-metropolitan hospital | Metropolitan CBOC | |
---|---|---|---|---|
n
|
193
|
106
|
23
|
64
|
Individual services n (%)
| ||||
Hormonal contraception | 182 (94) | 102 (96) | 22 (96) | 58 (91) |
IUD placement | 97 (50) | 70 (66) | 9 (39) | 18 (28) |
Infertility evaluation or treatment | 57 (30) | 39 (37) | 8 (35) | 10 (16) |
Infertility evaluation only | 29 (15) | 19 (18) | 5 (22) | 5 (8) |
Infertility treatment only | 6 (3) | 6 (6) | 0 | 0 |
Infertility evaluation or treatment | 22 (11) | 14 (13) | 3 (13) | 5 (8) |
Prenatal care | 11 (6) | 7 (7) | 0 | 4 (6) |
Number of services out of four n (%)
| ||||
None | 10 (5) | 3 (3) | 1 (4) | 6 (9) |
One | 74 (38) | 29 (27) | 11 (48) | 34 (53) |
Two | 56 (29) | 35 (33) | 5 (22) | 16 (25) |
Three | 51 (26) | 37 (35) | 6 (26) | 8 (13) |
Four | 2 (1) | 2 (2) | 0 | 0 |
Combinations of services
| ||||
One service (n = 74) | ||||
Hormonal contraception | 73 (99) | 28 (97) | 11 (100) | 34 (100) |
IUD placement | 1 (1) | 1 (3) | 0 | 0 |
Infertility evaluation or treatment | 0 | 0 | 0 | 0 |
Prenatal care | 0 | 0 | 0 | 0 |
Two services (n = 56) | ||||
Hormonal contraception and IUD placement | 47 (84) | 31 (89) | 3 (60) | 13 (81) |
Hormonal contraception and prenatal care | 1 (2) | 1 (3) | 0 | 0 |
Hormonal contraception and infertility evaluation or treatment | 8 (14) | 3 (8) | 2 (40) | 3 (19) |
IUD placement and prenatal care | 0 | 0 | 0 | 0 |
IUD placement and infertility evaluation or treatment | 0 | 0 | 0 | 0 |
Prenatal care and infertility evaluation or treatment | 0 | 0 | 0 | 0 |
Three services (n = 51) | ||||
Hormonal contraception, IUD placement, and infertility evaluation or treatment | 43 (84) | 29 (88) | 5 (100) | 4 (50) |
Hormonal contraception, IUD placement, and prenatal care | 4 (8) | 3 (8) | 0 | 1 (12) |
Hormonal contraception, prenatal care, and infertility evaluation or treatment | 4 (8) | 1 (3) | 0 | 3 (38) |
IUD placement, infertility evaluation or treatment, and prenatal care | 0 | 0 | 0 | 0 |
Hormonal contraception | IUD placement | |||||
---|---|---|---|---|---|---|
Availability: | No | Yes |
p
| No | Yes |
p
|
n
|
11
|
182
|
96
|
97
| ||
Practice context
| ||||||
Region n (%) | ||||||
Northeast | 1 (9) | 29 (16) | 0.31 | 16 (17) | 14 (14) | 0.65 |
Midwest | 1 (9) | 43 (24) | 25 (26) | 19 (20) | ||
South | 4 (36) | 69 (38) | 34 (35) | 39 (40) | ||
West | 5 (46) | 41 (23) | 21 (22) | 25 (26) | ||
Organization of the practice
| ||||||
≥ 1,209 women Veterans in 2006 | 5 (46) | 92 (51) | 0.73 | 29 (30) | 68 (71) | < 0.001 |
Women’s health clinic for primary care n (%) | 2 (18) | 128 (70) | 0.001 | 52 (54) | 78 (80) | < 0.001 |
Gynecology clinic n (%) | 2 (18) | 83 (46) | 0.12 | 19 (20) | 66 (68) | < 0.001 |
Resources: always or usually sufficient n (%) | ||||||
Clinical expertise | 6 (55) | 154 (86) | 0.01 | 77 (81) | 83 (87) | 0.02 |
Same gender providers | 6 (55) | 145 (83) | 0.02 | 76 (80) | 78 (83) | 0.60 |
Nursing staff | 6 (55) | 136 (76) | 0.12 | 68 (72) | 74 (77) | 0.38 |
Administrative and support staff | 5 (46) | 103 (57) | 0.45 | 56 (59) | 52 (54) | 0.51 |
Clinic space | 7 (64) | 118 (66) | 1.00 | 66 (70) | 59 (62) | 0.24 |
Properly equipped examination rooms | 7 (78) | 176 (97) | 0.04 | 89 (95) | 94 (97) | 0.72 |
Female attendants | 7 (70) | 156 (87) | 0.16 | 77 (83) | 86 (87) | 0.25 |
Budget or funding | 3 (38) | 70 (47) | 0.73 | 36 (49) | 37 (44) | 0.56 |
Formal women’s health training n (%) | 1 (9) | 15 (8) | 1.00 | 4 (4) | 12 (13) | 0.07 |
Separate budget or control point n (%) | 1 (9) | 31 (18) | 0.69 | 10 (11) | 22 (23) | 0.03 |
Change in resources over the last 2 years n (%) | ||||||
Increased | 1 (9) | 61 (34) | 0.20 | 26 (27) | 36 (38) | 0.35 |
Decreased | 2 (18) | 21 (13) | 14 (15) | 12 (13) | ||
Unchanged | 8 (73) | 94 (53) | 54 (58) | 48 (50) |
Infertility evaluation/treatment | Prenatal care | |||||
---|---|---|---|---|---|---|
Availability: | No | Yes |
p
| No | Yes |
p
|
n
|
136
|
57
|
182
|
11
| ||
Practice context
| ||||||
Region n (%) | ||||||
Northeast | 22 (16) | 8 (14) | 0.93 | 26 (14) | 4 (36) | n/aa
|
Midwest | 32 (24) | 12 (21) | 44 (24) | 0 | ||
South | 51 (38) | 22 (39) | 73 (40) | 0 | ||
West | 31 (23) | 15 (26) | 39 (21) | 7 (64) | ||
Organization of the practice
| ||||||
≥1,209 women Veterans in 2006 | 58 (43) | 39 (68) | 0.001 | 88 (49) | 9 (82) | 0.06 |
Women’s health clinic for primary care n (%) | 86 (63) | 44 (77) | 0.06 | 123 (68) | 7 (64) | 0.75 |
Gynecology clinic n (%) | 51 (38) | 34 (60) | 0.01 | 80 (44) | 5 (46) | 0.92 |
Resources: always or usually sufficient n (%) | ||||||
Clinical expertise | 106 (80) | 54 (95) | 0.01 | 151 (84) | 9 (82) | 0.69 |
Same gender providers | 104 (78) | 50 (89) | 0.08 | 146 (82) | 8 (73) | 0.43 |
Nursing staff | 99 (74) | 43 (75) | 0.82 | 137 (76) | 5 (46) | 0.03 |
Administrative and support staff | 83 (62) | 25 (44) | 0.02 | 101 (56) | 7 (64) | 0.76 |
Clinic space | 86 (65) | 39 (68) | 0.66 | 117 (66) | 8 (73) | 0.75 |
Properly equipped examination rooms | 130 (98) | 53 (93) | 0.20 | 173 (97) | 10 (91) | 0.35 |
Female attendants | 116 (87) | 47 (83) | 0.39 | 158 (88) | 5 (46) | 0.001 |
Budget or funding | 49 (45) | 24 (48) | 0.76 | 69 (47) | 4 (36) | 0.55 |
Formal women’s health training n (%) | 12 (9) | 4 (7) | 0.78 | 13 (7) | 3 (30) | 0.04 |
Separate budget or control point n (%) | 18 (14) | 14 (25) | 0.07 | 32 (18) | 0 | n/aa
|
Change in resources over the last 2 years n (%) | 38 (28) | 24 (44) | 0.01 | |||
Increased | 15 (11) | 11 (20) | 59 (33) | 3 (30) | n/aa
| |
Decreased | 82 (61) | 20 (36) | 26 (14) | 0 | ||
Unchanged | 38 (28) | 24 (44) | 0.01 | 95 (52) | 7 (70) |