Session #A1
October 28, 2011
10:30 AM
Comprehensive Primary Care for
Women Veterans
Sally Haskell, MD
Acting 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 13 th Annual Conference
October 27-29, 2011
Philadelphia

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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Women Users Doubled since 2000
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.
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Age Distribution: Three Peaks
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.
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Mission
• Ensure all women Veterans receive equitable , highquality , 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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Implementing Comprehensive Primary
Care for Women Veterans
Complete primary care from one designated
Women’s Health Primary Care Provider at one site
(including CBOCs)
 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-based
 Patient-centered
 Accessible
 Coordinated
 Comprehensive
 Continuous
 Focused on continuous improvement
PACT Teamlets typically composed of Provider, Clerk,
Registered Nurse, Health Technologist, extended team members
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Women’s Health PACT: Unique Needs
• Influx of younger women
• Reproductive health care
• Maternity care
• Mental health
• Musculoskeletal injuries
• Chronic pain
• Cardiovascular risk prevention
• Privacy, safety, convenience
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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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Models of Care
• 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 colocates primary care, gynecology, mental health and other services for women Veterans.
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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, preconception 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 management
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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
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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:
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Reaching out to Women Veterans through Call Center
Improving Privacy and Environment of Care
Ending Homelessness
Improving care coordination
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Women’s Health Transformation Initiative
• Sub-Initiative of New Models of Care
Improved Care Coordination
Emergency room care
 Assessment tool development
 Ongoing provider/staff education
Breast cancer
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Tracking of abnormal test results
Breast Cancer Clinical Case Registry
Teratogenic identification of drugs
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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 Program
 1100+ primary care providers educated
 Flagship education model for VA
 SimLEARN 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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Women’s Health Evaluation Initiative
 Acquiring data on the population of women Veterans
 Producing key sociodemographic and VHA health care utilization data
Goal: Understand the effects of military service on women’s lives
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Questions?
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Session Evaluation
Please complete and return the evaluation form to the classroom monitor before leaving this session.
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