UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Behavior and Behavior Mechanisms | Epidemiology | Health Services Administration | Health Services Research | Maternal and Child Health | Military and Veterans Studies | Obstetrics and Gynecology | Women's Health


BACKGROUND: An increasing number of women veterans are using VA maternity benefits for their pregnancies. However, because the VA does not offer obstetrical care, women must seek maternity care from non-VA providers. The growing number of women using non-VA care has increased the importance of understanding how this care is integrated with ongoing VA medical and mental health services and how perceptions of care integration impact healthcare utilization. Therefore, we sought to understand these relationships among a sample of postpartum veterans utilizing VA maternity benefits.

METHODS: We fielded a modified version of the Patient Perceptions of Integrated Care survey among a sample of postpartum veterans who had utilized VA maternity benefits for their pregnancies (n = 276). We assessed relationships between perceptions of six domains of patient-reported integrated care, indicating how well-integrated patients perceived the care received from VA and non-VA clinicians, and utilization of mental healthcare following pregnancy.

RESULTS: Domain scores were highest for items focused on VA care, including test result communication and VA provider's knowledge of patient's medical conditions. Scores were lower for obstetrician's knowledge of patient's medical history. Women with depressive symptom scores indicative of depression rated test result communication as highly integrated, while women who received mental healthcare following pregnancy had low integrated care ratings for the Support for Medication and Home Health Management domain, indicating a lack of support for mental health conditions following pregnancy.

DISCUSSION: Among a group of postpartum veterans, poor ratings of integrated care across some domains were associated with higher rates of mental healthcare use following pregnancy. Further assessment of integrated care by patients may assist VA providers and policymakers in developing systems to ensure integrated care for veterans who receive care outside the VA.


care coordination, pregnancy, veterans

Rights and Permissions

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019.

DOI of Published Version



J Gen Intern Med. 2019 May;34(Suppl 1):50-57. doi: 10.1007/s11606-019-04974-z. Link to article on publisher's site

Journal/Book/Conference Title

Journal of general internal medicine

PubMed ID


Related Resources

Link to Article in PubMed