Abstract P373: Health Care Access and Usage Patterns Among Native Americans: The Strong Heart Study

Abstract

Introduction: Previous research has shown that health care access and usage patterns among Native Americans are often difficult to measure. Hypothesis: We hypothesize that sociodemographic factors such as age, gender, education, and employment influence health care access and usage patterns in Native communities in the Strong Heart Study (SHS). Methods: The SHS is a prospective population-based epidemiological study of cardiovascular disease and its associated risk factors in American Indians (AI). Between 1997 and 1999, surviving participants (N=2,382) of the original cohort were invited to a third exam, in which health care access and usage information were collected, along with other clinical and sociodemographic measurements. Multivariate logistic regression was used to find influencing factors of health care choices. Results: The majority of study participants (79%, 1,877/2,382) reported Indian Health Services (IHS) as their primary source of care, and close to one-third (29%, 689/2,358) reported having no additional coverage. Figure 1 showed travel time, waiting time after arriving at the clinics, and waiting time of a walk-in visit in IHS, tribal health service, and private practice. As participants aging or obtaining more years of education, they were less likely to use public (IHS or tribal) health service vs. private practice with odds ratio (95% confidence interval) 0.97 (0.95-0.99, p<0.01) and 0.89 (0.84-0.93, p<0.01) respectively, adjusting for gender and employment status. Conclusions: SHS participants primarily utilize IHS compared to other health services. Average waiting time is longer for IHS facilities (vs. private practice or tribal health facilities) with 35% (622/1,760) participants waiting for > 60 minutes to be seen in regular appointments, and with 53% (814/1,540) participants waiting for > 60 minutes in a walk-in visit. Age and education influence access to and selection of health care services for AI. This report provides baseline information for future health care access study in SHS.