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.
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.
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DOI：
10.1111/1475-6773.14260
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发表时间：
2024-02
影响因子：
3.4
通讯作者：
Washington, Donna L.
中科院分区：
文献类型：
--
作者：
Shannon, Evan Michael;Steers, W. Neil;Washington, Donna L.
关键词：
研究患者感知的获得初级保健在调节和缓和退伍军人健康管理局(VA)使用者在高血压控制和糖尿病控制方面的种族和民族差异方面的作用。我们对2016-2019财年的国家退伍军人管理局用户管理数据进行了二次分析。我们的主要接触是种族或民族，主要结果是在已知疾病的患者中高血压控制(14090 )和糖尿病控制(HgbA1c <；9%)的二元指标。我们使用反向赔率加权方法来测试中介和Logistic回归，并使用种族和民族-感知访问交互产品术语来测试适度。所有的模特都根据年龄、性别、社会经济地位、乡村生活、教育程度、自评身心健康和合并症进行了调整。我们纳入了来自外部同行评审计划的具有高血压和糖尿病控制数据的退伍军人管理局用户，他们同时完成了以患者为中心的医疗之家的医疗体验调查。高血压(34,233名患者)和糖尿病(23,039名患者)样本分别进行了分析。调整后，黑人患者的高血压控制率显著低于白人患者(75.5%比78.8%，p <； 0.01)；黑人患者(81.8%)和西班牙裔患者(80.4%)的糖尿病控制率均显著低于白人患者(85.9%，p <； 0.01)。在这两个样本中，黑人、多种族、夏威夷原住民和其他太平洋岛民的感知接入都低于白人患者。没有证据表明感知到的获得性在黑人种族、西班牙裔种族和高血压或糖尿病控制之间的联系中起到了中介或缓和作用。我们观察了小数化患者在高血压和糖尿病控制方面的差异。没有证据表明患者对获得初级保健的感知调节或缓和了这些差异。在高血压和糖尿病控制方面减少退伍军人事务部内的种族和民族差异可能需要更多的干预措施，而不是那些侧重于改善患者获得机会的干预措施。
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. We performed a secondary analysis of national VA user administrative data for fiscal years 2016–2019. Our primary exposure was race or ethnicity and primary outcomes were binary indicators of hypertension control (<140/90 mmHg) and diabetes control (HgbA1c < 9%) among patients with known disease. We used the inverse odds‐weighting method to test for mediation and logistic regression with race and ethnicity‐by‐perceived access interaction product terms to test moderation. All models were adjusted for age, sex, socioeconomic status, rurality, education, self‐rated physical and mental health, and comorbidities. 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. 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. 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.
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影响因子：
3.4
作者：
Martino, Steven C.;Mathews, Megan;Elliott, Marc N.
通讯作者：
Elliott, Marc N.
DOI：
10.5034/inquiryjrnl_42.1.29
发表时间：
2005-03-01
影响因子：
1.7
作者：
Fortney, JC;Maciejewski, ML;Burgess, JF
通讯作者：
Burgess, JF
影响因子：
3
作者：
Hausmann, Leslie R. M.;Gao, Shasha;Fine, Michael J.
通讯作者：
Fine, Michael J.
影响因子：
3
作者：
Liu, Chuan-Fen;Manning, Willard G.;Maciejewski, Matthew L.
通讯作者：
Maciejewski, Matthew L.
影响因子：
4.8
作者：
Cu A;Meister S;Lefebvre B;Ridde V
通讯作者：
Ridde V