Comprehensive Primary Care for Women Veterans

Sally Haskell, MDActing Director, Comprehensive Women’s Health

Women Veterans Health Strategic Health Care Group, Patient Care Services,

U.S. Department of Veterans Affairs

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011

Philadelphia

Session #A1October 28, 201110:30 AM

Faculty Disclosure

Please add the commercial interest disclosures that you reported on your signed Disclosure form:

I have not had any relevant financial relationships during the past 12 months.

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Overview

• Describe Comprehensive Women Veterans Health Care

• Describe Models of Care for Women Veterans• Describe how VA Women’s Health aligns with Patient

Aligned Care Team Model (PACT Model)• Give examples of Women’s Health PACT in Veterans

Health Administration (VHA)

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Expected Outcome

• Participants will gain an understanding of Women Veterans Health Care

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Comprehensive Primary Care for Women Veterans

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Number of women Veteran VHA patients in each year, FY00-FY10

Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use of VHA Care, 2011.

Women Users Doubled since 2000

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Source: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group; Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use of VHA Care, 2011.

Age Distribution: Three Peaks

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Mission

• Ensure all women Veterans receive equitable, high-quality, and comprehensive health care services in a sensitive and safe environment at all VA facilities

• Be a national leader in the provision of health care for women Veterans, thereby raising the standard of care for all women

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Transforming Health Care Delivery for Women Veterans

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Revised Guidelines on “VHA Services for Women Veterans”

• Outlines specific services at facilities and Community Based Outpatient Clinics (CBOCs)

• Defines “Comprehensive Primary Care for Women Veterans”

• Requires women be seen by Women’s Health Primary Care Providers

• Offers three clinic models• Details safety and security requirements• Establishes systematic data collection process

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Complete primary care from one designated Women’s Health Primary Care Provider at one site (including CBOCs)

Implementing Comprehensive Primary Care for Women Veterans

Care for acute and chronic illness Gender-specific primary care Preventive services Mental health services Coordination of care Model for PACT Measured with Women’s

Assessment Tool for Comprehensive Health (WATCH)

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VA Patient-Aligned Care Teams: PACT

• PACTs deliver primary care that is:Team-basedPatient-centeredAccessibleCoordinatedComprehensiveContinuousFocused on continuous improvement

PACT Teamlets typically composed of Provider, Clerk, Registered Nurse, Health Technologist, extended team members 1210/27/2011

• Influx of younger women• Reproductive health care• Maternity care• Mental health• Musculoskeletal injuries• Chronic pain• Cardiovascular risk prevention• Privacy, safety, convenience

Women’s Health PACT: Unique Needs

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Women’s Health PACT: Unique Needs

• Older women (largest sub-population of female VA users)

• Menopausal needs• Mental health• Chronic pain• Cardiovascular disease • Osteoporosis• Cancer• Privacy, safety, convenience• Geriatric Care

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• Model 1: Integrated Primary Care Clinic—Comprehensive primary care is delivered by a designated women’s health provider in a gender neutral primary care clinic.

• Model 2: Separate but Shared Space—Comprehensive primary care is offered by a designated women’s health provider in a separate or shared space that may be located adjacent to or near primary care.

• Model 3: Comprehensive Women’s Clinic—VHA facilities with larger women’s populations are encouraged to create comprehensive women’s clinics in exclusive separate space, that co-locates primary care, gynecology, mental health and other services for women Veterans.

Models of Care

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Women’s Health PACT Teamlets in all Models of Care

• Every care site should have Designated Women’s Health Providers (WH PCP) who are interested and proficient in women’s health

• To maintain proficiency, each designated WH PCP must be comprised of at least 10% female patients or site must have alternative plan to maintain proficiency

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Women’s Health PACT Teamlet Implementation Examples

RN specific knowledge and skills:• Mammogram tracking, coordination with breast

surgeons, oncologists• Gynecology procedures, assistance, and post-op

patient follow up (for co-located GYN)• Pap smear tracking and follow up• Specific injections, Depo-Provera, Lupron, Gardasil• Patient education-including contraception, pre-

conception care and planning, pre-natal care, others.

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Women’s Health PACT Teamlet Implementation Examples

Health Tech specific knowledge and skills:• Act as Chaperone• Assess environment for Privacy, Safety, Dignity• Be familiar with issues such as MST• Set-up and assist with GYN exam• Deliver cultures, Paps, other samples to lab• Review patients coming in each week, huddle with provider• Communicate with patients—prior to visit and follow up as

needed• Have a role/responsibility for PACT team population

management18

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Women’s Health PACT Teamlet Extended Team Members

• Primary care mental health integration team (with Women’s Mental Health expertise)

• Military Sexual Trauma Coordinator• Gynecologist• Social Work• Care Coordination and Fee Services• Pharmacist with Women’s Health expertise:

medications in women who may be pregnant or lactating Gender-specific medications such as OCPs and HT management of gender disparities in lipids, DM

• Nutritionist 19

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Reproductive Health Care Challenges

• Screening and care of common reproductive health issues provided by Designated Women’s Health Provider

• Must ensure daily access within PACT Teamlet to a Designated Women’s Health provider for urgent care needs

• More complex gynecological care provided by Gynecologist, ideally co-located with Women’s Health Teamlet, or by Fee Basis

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Developing a Population Perspective

• Eliminate gender disparities in screening and prevention

• Use population tools, tracking systems for Pap smears, Mammograms

• Track those at high risk of CVD or DM• Screen for MST/IPV• Offer preconception counseling• Manage obesity/increase exercise• Prevent development of Chronic Pain

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Women’s Health Transformation Initiative

• Implementing comprehensive primary care is one piece of VA Women’s Health Transformation Initiative. Other pieces include: Reaching out to Women Veterans through Call Center Improving Privacy and Environment of Care Ending Homelessness Improving care coordination

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• Sub-Initiative of New Models of Care

Improved Care Coordination

Emergency room care Assessment tool development Ongoing provider/staff education

Breast cancer Tracking of abnormal test results Breast Cancer Clinical Case Registry

Teratogenic identification of drugs

Women’s Health Transformation Initiative

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Women’s Health Education

• Recruiting and retraining providers interested and proficient in women’s health

National Women’s Health Mini-Residency Program1100+ primary care providers educatedFlagship education model for VASimLEARN partnership: Large mini-residency, ED-WH

curriculum, task trainer dissemination• Advanced Fellowships• VA Cyber Seminar Spotlight on Women’s Health• VA Women’s Health Research Conference

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Acquiring data on the population of women Veterans Producing key sociodemographic and VHA health care

utilization dataGoal: Understand the effects of military service on women’s lives

Women’s Health Evaluation Initiative

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Questions?

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Session Evaluation

Please complete and return theevaluation form to the classroom monitor before

leaving this session.

Thank you!

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