1. Investigation of the role of perceived access to primary care in mediating and moderating racial and ethnic disparities in chronic disease control in the veterans health administration
- Author
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Shannon, Evan Michael, Steers, W. Neil, and Washington, Donna L.
- Subjects
United States. Department of Veterans Affairs -- Investigations ,Investigations ,Company legal issue ,Chronic diseases -- Investigations ,Mediation -- Investigations ,Diabetes mellitus -- Investigations ,Hypertension -- Investigations ,Veterans -- Investigations ,Medical research -- Investigations ,Diabetes therapy -- Investigations ,Medicine, Experimental -- Investigations ,Diabetes -- Investigations - Abstract
1 | INTRODUCTION Disparities in chronic disease control between racially and ethnically minoritized (hereafter referred to as 'minoritized') and non-Hispanic White (hereafter 'White') primary care patients in the United States [...], Objective: To examine the role of patient-perceived access to primary care in mediating and moderating racial and ethnic disparities in hypertension control and diabetes control among Veterans Health Administration (VA) users. Data Source and Study Setting: We performed a secondary analysis of national VA user administrative data for fiscal years 2016-2019. Study Design: Our primary exposure was race or ethnicity and primary outcomes were binary indicators of hypertension control ( Data Collection/Extraction Methods: We included VA users with hypertension and diabetes control data from the External Peer Review Program who had contemporaneously completed the Survey of Healthcare Experience of Patients-Patient-Centered Medical Home. Hypertension (34,233 patients) and diabetes (23,039 patients) samples were analyzed separately. Principal Findings: After adjustment, Black patients had significantly lower rates of hypertension control than White patients (75.5% vs. 78.8%, p < 0.01); both Black (81.8%) and Hispanic (80.4%) patients had significantly lower rates of diabetes control than White patients (85.9%, p < 0.01 for both differences). Perceived access was lower among Black, Multi-Race and Native Hawaiian and Other Pacific Islanders compared to White patients in both samples. There was no evidence that perceived access mediated or moderated associations between Black race, Hispanic ethnicity, and hypertension or diabetes control. Conclusions: We observed disparities in hypertension and diabetes control among minoritized patients. There was no evidence that patients' perception of access to primary care mediated or moderated these disparities. Reducing racial and ethnic disparities within VA in hypertension and diabetes control may require interventions beyond those focused on improving patient access. KEYWORDS access to primary care; diabetes mellitus; health disparate, minority, and vulnerable populations; hypertension; mediation analysis; veterans health services What is known on this topic * There are documented racial and ethnic disparities in hypertension and diabetes control among minoritized groups, including in the Veterans Health Administration (VA). * Racial and ethnic disparities in primary care access have also been documented, however, the role that perceived access plays in disparities in chronic disease control remains unknown. What this study adds * This study identified persistent disparities in hypertension and diabetes control for Black and both Black and Hispanic (respectively) VA users who sought primary care at VA clinics, compared to non-Hispanic White patients. * There was no evidence that perceived access mediated or moderated racial and ethnic disparities in hypertension and diabetes control.
- Published
- 2024
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