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    Factors Impacting Perceived Access to Early Prenatal Care among Pregnant Veterans Enrolled in the Department of Veterans Affairs

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    Authors
    Mattocks, Kristin M.
    Baldor, Rebecca
    Bean-Mayberry, Bevanne
    Cucciare, Michael
    Gerber, Megan R
    Goldstein, Karen M.
    Hammer, Kimberly D.
    Hill, Elizabeth E.
    Kroll-Desrosiers, Aimee
    Prochazka, Allan V.
    Sadler, Anne G.
    Bastian, Lori
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    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2019-01-01
    Keywords
    Epidemiology
    Health Services Administration
    Health Services Research
    Maternal and Child Health
    Military and Veterans Studies
    Obstetrics and Gynecology
    Women's Health
    
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    Link to Full Text
    https://doi.org/10.1016/j.whi.2018.10.001
    Abstract
    BACKGROUND: Despite the relatively recent Department of Veterans Affairs (VA) policy advances in providing care for veterans and their infants during the perinatal period, little information exists regarding access to prenatal care for women veterans. Currently, VA medical centers do not provide onsite pregnancy care for veterans, but pay for care from community obstetricians through the Veterans Choice Program (VCP) and related non-VA care programs. The VCP is subcontracted to two large contractors, Health Net and TriWest, to assist the VA in administering the VCP. To date, no studies have evaluated women's perceived access to prenatal care under the VCP. OBJECTIVE: The purpose of this study was to understand pregnant veterans' perceived access to community prenatal care through the VCP. DESIGN: The Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study is a longitudinal, prospective multisite observational cohort study of pregnant and postpartum veterans at 15 VA facilities nationwide. Telephone surveys were conducted with women veterans at 20 weeks of pregnancy. We used multivariable logistic regression to examine the odds of receiving care early enough adjusted for these key factors. Measures included perceived access to early prenatal care by race, age, marital status, history of mental health conditions, urban/rural residence, and the VCP contractor (Health Net vs. TriWest). RESULTS: Overall, 519 women veterans completed the baseline pregnancy survey. A sizeable proportion of participants reported a history of mental health conditions, including depression (56.7%), anxiety disorder (45.5%), and posttraumatic stress disorder (40.5%). White veterans were more likely to report perceived timely access to prenatal care than minority veterans (66% vs. 52%; p = .0038). Veterans receiving care at Health Net facilities were more likely to report receiving prenatal care as early as desired in comparison to veterans at TriWest facilities (adjusted odds ratio, 0.48; 95% CI, 0.32-0.73), whereas veterans with a history of depression were 1.7 times more likely to report perceived delays in desired prenatal care compared with veterans without a history of depression (adjusted odds ratio, 1.65; 95% CI, 1.08-2.53). CONCLUSIONS: We found that nearly one-third of women reported problems receiving early prenatal care as soon as they would have liked. Women with histories of depression and racial minorities may require additional maternity care coordination services to ensure they receive timely prenatal care. Community-based provider networks under the VCP should continue to be expanded so that pregnant veterans are able to access high-quality prenatal care in a timely manner.
    Source

    Womens Health Issues. 2019 Jan - Feb;29(1):56-63. doi: 10.1016/j.whi.2018.10.001. Epub 2018 Nov 13. Link to article on publisher's site

    DOI
    10.1016/j.whi.2018.10.001
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/46787
    PubMed ID
    30446330
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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1016/j.whi.2018.10.001
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