Demographics and Health Status
The analytic sample included 971 women, 61.7% from WCs and 38.3% from TCs (). Patients in WCs were significantly younger (mean age 55.5 vs 62.9 years; P < .001) and more likely to be nonwhite (15.5% WC vs 9.4% TC; P < .02). Most of the nonwhite women described themselves as black or African American (11.5% WC vs 6.7% TC). Marital status, educational status, income, and overall health did not differ between the 2 clinic types.
Patient Characteristics by Clinic
Health Care Use
Patients in WCs were more likely to use only the VA system for their health care compared to patients in TCs. While similar proportions of women in each clinic had seen their regular provider at the most recent visit (79.3% WC vs 78.2% TC; NS), more patients in WCs had seen other VA providers (65.3% WC vs 54.0% TC; P < .001) during the same time frame and reported lower use of non-VA physicians on a regular basis (30.9% WC vs 52.4% TC; P < .001).
Bivariate Satisfaction Results
We analyzed responses to 28 of 29 individual items on the PCSSW to identify questions that demonstrated significant differences between ratings in the 2 clinic populations. The item on childcare accommodation, within the domain of getting care, was not analyzed because of patient misinterpretation and lack of applicability. On 19 of 28 remaining items, WC patients more frequently gave ratings of excellent than TC patients. None of the items had higher rates of excellent satisfaction in TC compared to WC (). Within the domain of getting care, questions on preference for a female provider and flexibility in scheduling an appointment had a greater percentage of patients with excellent satisfaction in the WCs. Within the domain of privacy and comfort, items related to patient dignity (e.g., chance to talk with my clothes on) and comfort (e.g., comfort during a gynecological exam) had highly significant differences between clinics. Under the communication domain, all items showed significant differences. These items reflect time allowed for talking and asking questions, sensitivity to patient issues (e.g., interest in mental health, sexual health, discussion of nontraditional therapies, increasing comfort with concerns, use of understandable language, explanation of tests, and sensitivity when answering questions), and the patient's overall confidence in her regular provider. For complete care, items that reflected a well-rounded visit (e.g., information on healthy living, care fits my age) as well as knowledge of women's health and disease prevention were rated significantly higher in WCs. Finally, in the domain of follow-up care, information on the next appointment needed was significantly different between clinics, while provision of test results or information on support groups and resources did not show any difference in ratings.
Excellent Satisfaction on Items in the PCSSW
In bivariate comparisons of the 2 clinics, over one third of patients in WCs reported excellent overall satisfaction compared to traditional clinics (35.7% WC vs 26.8% TC; P = .005) (). Women's clinics had a significantly higher proportion with excellent ratings within the domains of complete care (13.5% WC vs 7.9% TC; P = .017) and communication (19.5% WC vs 12.2% TC; P = .008). For the other domains (e.g., getting care, privacy and comfort, and follow-up care), the unadjusted percentage with excellent ratings was similar between clinics.
Percent Excellent for All Items in a Domain and on Overall Satisfaction
Multivariate Satisfaction Results
In multivariate logistic regression analyses controlling for age, race, level of education, marital status, income, health status, recent visit with primary care provider, use of other VA providers, use of a regular non-VA physician, and site with 7 dummy covariates, female veterans who were seen in WCs were more likely to have excellent satisfaction compared to those seen in TCs; P = .05 (odds ratio [OR], 1.42; 95% confidence interval [95% CI], 1.00 to 2.02) (). Similarly, for every domain of the PCSSW, patients seen in the WC were significantly more likely to report a perfect satisfaction score: getting care (OR, 1.69; 95% CI, 1.14 to 2.49; P = .008); privacy and comfort (OR, 1.63; 95% CI, 1.11 to 2.39; P = .013); communication (OR, 1.66; 95% CI, 1.16 to 2.37; P = .006); complete care (OR, 1.69; 95% CI, 1.17 to 2.43; P = .005); and follow-up care (OR, 1.70; 95% CI, 1.16 to 2.47; P = .006).
Odds of Excellent Overall Satisfaction or Perfect Score on a Satisfaction Domain Adjusted (95% CI)
As in other studies, increasing age, better health status, and recent visit with a primary care provider were all associated with higher overall satisfaction, while higher education was associated with lower satisfaction. Additionally, recently seeing your regular provider and better health status were significantly associated with a perfect score across all 5 satisfaction domains. While higher education had a negative influence on the domain of getting care, it did not show any influence on the other 4 satisfaction domains.