Usual Care Among Providers Treating Women Veterans: Managing Complexity and Multimorbidity in the Era of Evidence-Based Practice

  • Alison B. HamiltonEmail author
  • Shannon Wiltsey-Stirman
  • Erin P. Finley
  • Ruth Klap
  • Brian S. Mittman
  • Elizabeth M. Yano
  • Sabine Oishi
Original Paper


To better understand VA providers’ approaches to and perspectives on providing care to women Veterans, providers (n = 97) in primary care and mental health settings were interviewed about women’s perceived treatment needs, types of care provided, and perceptions of evidence-based treatments (EBTs) for this population. Providers perceived that women Veteran VA users are often diagnostically complex and require a coordinated approach to treatment planning. They struggled with decisions about how to offer services such as EBTs and collaborative care in light of comorbidity and psychosocial stressors, and endorsed the belief that a tailored approach and consideration of these factors is essential in providing care.


Women’s mental health Evidence-based practice Veterans 



These data were collected as part of an evaluation of VA implementation of tele-gynecology in partnership with Women’s Health Services: The Evaluation of Tele-Gynecology Implementation (Project # XVA 65-028), funded by Women’s Health Services, Office of Patient Care Services, Veterans Heath Administration. Dr. Yano’s effort was funded by a VA HSR&D Senior Research Career Scientist Award (Project # RCS 05-195). At the time of the project, Dr. Hamilton and Dr. Wiltsey-Stirman were investigators with the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University, St. Louis; supported through an award from the National Institute of Mental Health (R25 MH080916) and VA HSR&D QUERI.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures were determined nonhuman subjects non-research by the VA Greater Los Angeles Institutional Review Board.

Informed Consent

Informed consent was obtained and verbally recorded from all individual participants included in the study.


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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.Department of Psychiatry and Biobehavioral Sciences, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  3. 3.Dissemination and Training DivisionNational Center for PTSD, VA Palo Alto Healthcare SystemMenlo ParkUSA
  4. 4.Department of Psychiatry and Biobehavioral SciencesStanford University School of MedicineStanfordUSA
  5. 5.Veterans Evidence-Based Research Dissemination and Implementation Center, Audie L. Murphy Memorial Veterans Hospital, South Texas Veterans Health Care SystemSan AntonioUSA
  6. 6.Division of Hospital Medicine, Departments of Medicine and PsychiatryUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  7. 7.Department of Research and Evaluation, Division of Health Services Research and Implementation ScienceKaiser PermanentePasadenaUSA
  8. 8.Department of Health Policy & Management, Fielding School of Public HealthUniversity of California Los AngelesLos AngelesUSA

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