Differences In Health Care Experiences Research Articles

Racial and Ethnic Differences in Health Care Experiences for Veterans Receiving VA Community Care from 2016 to 2021.

Prior research documented racial and ethnic disparities in health care experiences within the Veterans Health Administration (VA). Little is known about such differences in VA-funded community care programs, through which a growing number of Veterans receive health care. Community care is available to Veterans when care is not available through the VA, nearby, or in a timely manner. To examine differences in Veterans' experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021. Observational analyses of Veterans' ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors. Respondents to the 2016-2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey. Care ratings in nine domains. The sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from - 0.04 to - 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted. This study identified small but persistent racial and ethnic differences in Veterans' experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans' patient experience could advance equity in VA community care.

United States Army Reserve/National Guard soldiers’ healthcare experiences, attitudes, and preferences: Differences based on deployment status

ABSTRACT Some United States Army Reserve/National Guard (USAR/NG) soldiers have substantial health needs, which may be service-related, but not necessarily resulting from deployment. However, most USAR/NG members need to have been deployed to qualify for Veterans Administration (VA) benefits. Therefore, many USAR/NG soldiers seek care from civilian healthcare providers (HCPs). Using a subset (N = 430 current/former soldiers) of Operation: SAFETY study data, we used regression models to examine differences in healthcare experiences, attitudes, and preferences by deployment status (never-deployed vs. previously-deployed). Final models controlled for age, sex, rank (enlisted vs. officer), military status (current vs. former military), and RAND SF-36 General Health Score. Over 40% of soldiers agreed that civilian HCPs should ask patients about their military service, but never-deployed soldiers were less likely to report being asked about their service (p < 0.05) or how their service affects their health (p < 0.10). Never-deployed soldiers were also less likely to attribute their health concerns to military service (p < 0.001). Although never-deployed soldiers were more likely to prefer receiving physical (p < 0.05) and mental (p < 0.05) healthcare outside of the VA than previously-deployed soldiers, never-deployed soldiers had low confidence in their HCP’s understanding of their needs (49% thought that their civilian HCP did not understand them; 71% did not think that their civilian HCP could address military-related health concerns; 76% thought that their civilian HCP did not understand military culture). Findings demonstrate that although civilian HCPs may be the preferred (and only) choice for never-deployed USAR/NG soldiers, they may need additional support to provide care to this population.

Differences in Health Care Experiences among Transgender and Gender Diverse Youth by Gender Identity and Race/Ethnicity.

Transgender and gender diverse (TGD) youth experience significant risk for negative health outcomes, yet few studies exist that address TGD youth's experiences of health care. This paper explores the equitable access and utilization of health care in a sample of TGD youth of diverse gender and racial/ethnic identities. Data for this analysis are from the TGD subsample (n = 1415) of the 2018 Survey of Today's Adolescent Relationships and Transitions (START) Project. We assessed five health care experiences: being insured, having a current health care provider, being out to one's provider, believing your provider was knowledgeable about transgender issues, and barriers to accessing care due to gender identity/expression. We examined the proportion of TGD youth who reported each of these outcomes and within-group differences by gender identity and race/ethnicity using descriptive statistics, logistic regression, and predicted probabilities. When differences were examined by gender identity, barriers to equitable care were consistently more present among transgender females than youth of other gender identities. There were few significant differences by race/ethnicity; however, dual referent models demonstrated barriers to equitable care were particularly evident among Black and Hispanic transgender women. We discuss these findings through the lens of intersectionality and highlight the importance of research and intervention work focused on reducing barriers to equitable care for TGD youth.

Binary and Nonbinary Transgender Adolescents' Healthcare Experiences, Avoidance, and Well Visits

PurposeTo explore differences in healthcare experiences, healthcare avoidance, and well visit attendance between binary and nonbinary transgender adolescents; also, to explore the association between distinct healthcare experiences and healthcare avoidance and well visits. MethodsWe surveyed transgender adolescents ages 12–26 (n = 156) recruited from a multidisciplinary gender clinic from July through November 2018. Differences in distinct healthcare experiences by demographics were assessed using multivariable linear regression. Multivariable logistic regression was used to examine independent associations between demographics and lifetime healthcare avoidance and past-year well visit and also, associations between distinct healthcare experiences and lifetime healthcare avoidance and past-year well visit. ResultsCompared to transfeminine adolescents, more non-affirming healthcare experiences were reported by nonbinary (β = 1.41, 95% confidence interval [CI]: 0.49, 2.33) and transmasculine adolescents (β = 0.78, 95% CI: 0.02, 1.53). Gender-affirming healthcare experiences did not differ by demographics. Transmasculine adolescents had over three times the odds of lifetime healthcare avoidance (adjusted odds ratio [aOR] = 3.58, 95% CI: 1.41, 9.08) than transfeminine peers. Only younger age was associated with past-year well visit (aOR = 3.83, 95% CI: 1.44, 10.17). Non-affirming healthcare experiences were positively associated with healthcare avoidance (aOR = 1.85, 95% CI: 1.47, 2.34). Gender-affirming healthcare experiences were not associated with healthcare avoidance or past-year well visit. DiscussionNonbinary and transmasculine adolescents experienced more non-affirming healthcare experiences than transfeminine adolescents. Non-affirming healthcare experiences were associated with healthcare avoidance, which was disproportionately more prevalent among transmasculine adolescents. Providers must be better equipped to provide inclusive, gender-affirming care to increase receipt of care for transgender adolescents beyond specialized gender clinics.

Differences in health care experiences between rare cancer and common cancer patients: results from a national cross-sectional survey

BackgroundPatients with rare cancers face challenges in the diagnostic and treatment phase, and in access to clinical expertise. Since studies on health care experiences of these patients in comparison to patients with more common cancers are scarce, we aimed to explore these differences.MethodsData were cross-sectionally collected among (former) adult cancer patients through a national online survey in the Netherlands (October 2019). Descriptive statistics were reported and subgroups (rare vs. common patients) were compared.ResultsIn total, 7343 patients (i.e., 1856 rare and 5487 common cancer patients) participated. Rare cancer patients were more often diagnosed and treated in different hospitals compared to common cancer patients (67% vs. 59%, p < 0.001). Rare cancer patients received treatment more often in a single hospital (60% vs. 57%, p = 0.014), but reported more negative experiences when treated in multiple hospitals than common cancer patients (14% vs. 9%, p < 0.001). They also more often received advise from their physician about the hospital to go to for a second opinion (50% vs. 36%, p < 0.001), were more likely to choose a hospital specialized in their cancer type (33% vs. 22%, p < 0.001), and were more willing to travel as long as necessary to receive specialized care than common cancer patients (55% vs. 47%, p < 0.001).ConclusionsRare and common cancer patients differ in their health care experiences. Health care for rare cancer patients can be further improved by proper referral to centers of expertise and building a clinical network specifically for rare cancers.

Disparities in Experience with Culturally Competent Care and Satisfaction with Care by Sexual Orientation.

Purpose: Prior studies have identified health care providers' lack of cultural competency as a major barrier to care among sexual minority individuals. However, little is known about disparities in experience with culturally competent care by sexual orientation at the population level. This study assessed experiences with culturally competent care and satisfaction with care across sexual orientation groups in the United States. Methods: We analyzed nationally representative data from the 2017 National Health Interview Survey (n = 21,620) with ordinal logit regression models and compared six aspects of health care experiences across sexual orientation groups. These were: preferences for and frequencies of seeing health care providers who understand or share their culture; perceived experiences of being treated with respect by providers and providers asking about their beliefs and opinions; access to easily understood health information from providers; and satisfaction with received care. Results: Relative to heterosexual men, gay men were more likely to consider it important for providers to understand or share their culture (odds ratio [OR] = 1.4, p < 0.05) and to have providers who ask for their opinions or beliefs about care (OR = 1.5, p < 0.01). Relative to heterosexual women, bisexual- and something else-identified women were less likely to report being treated with respect (ORs = 0.4-0.6, p's < 0.01) and satisfaction with care (ORs = 0.5-0.6, p's < 0.05). No statistical differences in health care experiences were found between other sexual minority groups and their heterosexual counterparts. Conclusions: Access to culturally competent care and satisfaction with care varied by sexual orientation and gender. Clinical practices should address the unique health care barriers faced by bisexual- and something else-identified women.

Intercultural differences in healthcare experiences of Latinos in a nontraditional destination area.

Background: Disparities in health care access for Latinos are well documented, but little is known about how they may impact immigrants from diverse countries of origin differently. Immigrants in nontraditional destination areas face greater disparities, allowing more robust comparison of Latino heritage groups in such regions. Method: Mexican (N = 258) and Guatemalan (N = 143) participants were recruited for a community-based participatory research (CBPR) initiative in Cincinnati, Ohio: Latinos Unidos por la Salud (LU-Salud). Community partners recruited Latino immigrants to complete a brief survey about health care difficulties. Mixed methods data analysis was employed using t tests, Fisher's exact test, and a qualitative content analysis approach to analyze group differences. Results: Although both groups reported challenges, Guatemalans reported greater difficulty navigating health care. Conversely, Mexicans more commonly used local resources like health fairs to seek health information and described fewer language barriers. Qualitatively, Guatemalans and Mexicans had different perceptions of the biggest health problem for Latinos in Cincinnati. Notably, Mexicans identified major chronic diseases as community health problems. Discussion: Mexicans and Guatemalans show different patterns of health care engagement and express distinct concerns. Future work should consider the role of health literacy in informing the heterogenous experiences and needs of Latinos from diverse countries of origin. Further, interventions should train health care providers to provide culturally sensitive services, with interpreters available in multiple languages to address heterogenous language needs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

HEALTHCARE EXPERIENCES OF NHOPI AND OTHER U.S. ASIAN MEDICARE BENEFICIARIES

Native Hawaiians and Other Pacific Islanders (NHOPI) and Asians are the fastest-growing US racial and ethnic group. Differences in healthcare experiences may contribute to the better health outcomes of Asian-Only adults than NHOPIs, but little is known about NHOPI healthcare experiences. Using data from 1067 NHOPI and 9361 Asian-Only Medicare beneficiaries responding to the 2017 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, we investigated NHOPI and Asian-Only differences in flu vaccination and six case-mix adjusted composite measures of healthcare experiences (scaled 0-100), with and without adjustment for Medicare coverage type and state of residence. Compared with Asian-Only beneficiaries, NHOPI beneficiaries reported better experiences getting needed care (adjusted-difference of +7 points), customer service (+5 points), doctor communication (+5 points), getting care quickly (+4 points), care coordination (+4 points), and getting needed prescription drugs (+3 points). In contrast, NHOPI beneficiaries reported worse flu immunization (-7 points; p<0.05 for all reported differences). Adjustment for Medicare Advantage (MA) coverage and state of residence accounted for <25% of differences. NHOPI vs. Asian-Only care experience differences were similar for MA and Fee-for-Service beneficiaries. NHOPI were immunized for influenza less often than Asian-Only beneficiaries in MA (-15 points), but not Fee-for-Service; this did not differ by gender. NHOPI men reported better experiences than Asian-Only men for customer service (+11 points) and getting care quickly (+6 points). Patient experience does not explain worse health outcomes found elsewhere for NHOPI than Asian-Only. Further study may suggest means of improving Asian-Only healthcare experiences and NHOPI immunization.

Obesity and Health Care Experiences among Women and Men Veterans.

Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care. Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n=13,462 women, n=268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics. The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women. It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.

Association of Income Disparities with Patient-Reported Healthcare Experience.

Disparities in health outcome exist among patients according to socioeconomic status. However, little is known regarding the differences in healthcare experiences across the various levels of income of patients. In a nationally representative US adult population, we evaluate the differences in healthcare experiences based on patient level of income. To evaluate the differences in patient healthcare experiences based on level of income. We identified 68,447 individuals (mean age, 48 ± 18years; 55% female) representing 176.8 million US adults, who had an established healthcare provider in the 2010-2013 Medical Expenditure Panel Survey cohort. This retrospective study examined the differences in all five patient-reported healthcare experience measures (access to care, provider responsiveness, patient-provider communication, shared decision-making, and patient satisfaction) under the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We examined the relationship between patient income and their healthcare experience. Overall, 32% of the study participants were high-income earners while 23% had very-low income. Lower income was consistently associated with poor patient report on healthcare experience. Compared with those with high income, very-low-income-earning participants had 1.63 times greater odds (OR 1.63, 95% CI 1.45-1.82) of experiencing difficulty accessing care, had 1.34 times higher odds (OR 1.34, 95% CI 1.25-1.45) of experiencing poor communication, had higher odds (OR 1.68, 95% CI 1.46-1.92) of experiencing delays in healthcare delivery, and were more likely to report poor provider satisfaction (OR 1.48, 95% CI 1.37-1.61). Lower income-earning patients have poorer healthcare experience in all aspects of access and quality of care. Targeted policies focusing on improving communication, engagement, and satisfaction are needed to enhance patient healthcare experience for this vulnerable population.

The impact of language barriers and immigration status on the care experience for Spanish-speaking caregivers of patients with pediatric cancer.

An increasing proportion of pediatric cancer patients in the United States are Latino and many have Spanish-speaking immigrant parents with limited English proficiency (LEP). Little is known about how language or undocumented immigration status impacts their care experience. A cross-sectional survey was administered to English (N=310) and Spanish-speaking LEP (N=56) caregivers of pediatric cancer patients. To assess differences in healthcare experiences between the language groups, t-tests and chi-square statistics were used. Multivariable logistic regression evaluated associations between primary language and knowledge of clinical trial status. Spanish-speaking caregivers were more likely to report higher rates of quitting or changing jobs as a direct result of their child's cancer, and their children were more likely to experience a delay in education. Although Spanish-speaking caregivers reported higher satisfaction with care, 32% reported feeling that their child would have received better care if English was their primary language. Spanish-speaking caregivers were more likely to incorrectly identify whether their child was on a clinical trial compared with English-speaking caregivers. The majority of Spanish-speaking caregivers reported at least one undocumented caregiver in the household and 11% of them avoided or delayed medical care for their child due to concerns over their undocumented immigration status. Language barriers and undocumented immigration status may negatively impact the quality of informed decision-making and the care experience for Spanish-speaking LEP caregivers of pediatric cancer patients. These families may benefit from culturally appropriate Spanish language resources to improve communication and open a dialogue regarding undocumented immigration status.

A qualitative analysis of women's satisfaction with primary care from a panel of focus groups in the National Centers of Excellence in Women's Health.

Health issues unique to women and differences in healthcare experiences have recently gained attention as health plans and systems seek to extend and improve health promotion and disease prevention in the population. Successful efforts focused on enhancing quality of care will require information from the patient's perspective on how to improve such services to best support women's attempts to lead healthy and productive lives. The National Centers of Excellence in Women's Health program (CoE), sponsored by the Office on Women's Health within the Department of Health and Human Services, is based on an integrated model uniting research, training, healthcare, and community education and outreach. To examine women's concept and definitions of healthcare quality, 18 focus groups comprising 137 women were conducted nationwide on experiences and attributes of healthcare that women value in primary care. Following the focus groups, a woman-focused healthcare satisfaction instrument was developed for the purpose of assessing and improving healthcare delivery. We describe the qualitative results of the focus group study.