2029. Barriers to Care: A New Instrument
MS Bauer, Providence VAMC & Brown University, WO Williford, Perry Point Cooperative Studies Coordinating Center, L McBride, Providence VAMC, K McBride, University of Connecticut

Objectives: Access to health care appears to be a major determinant of health outcome, and is of major concern to the VHA.  While community-based studies have measured access—or its inverse, barriers—to health care with a small number of questions in large surveys, we are aware of no psychometrically valid and reliable instruments with which to measure the construct of perceived barriers to healthcare.  Moreover, we are aware of no instruments designed to measure barriers perceived by those currently treated in the healthcare setting who, although they have been able to access care, may still experience significant barriers to optimal care.

Methods: An interview-based ordinal-scored 29-item instrument was developed based on existing survey items and review of available clinical and theoretical literature.  It was administered to 312 veterans at the Providence VAMC presenting for a primary care or mental health appointment. A subsample of 27 had the instrument re-administered 3-6 weeks after the initial interview to investigate test-retest reliability. Test-retest reliability was assessed with paired t-test and Spearman’s correlation coefficient. Principal components analysis with varimax rotation was used to identify major factors. Validity was investigated by analyzing scores across subgroups of subjects hypothesized a priori to differ in perceived barriers.

Results:  No item showed significant drift by paired t-test, and 28 of 29 showed highly significant correlations between administrations. Principal components analysis revealed 4 main factors (with eigenvalues): Telephone (2.284), Distance (2.374), Provider Communication (1.719), and Travel Difficulties (1.648).  Factors explained 67% of total item variance.  Analysis of external validators confirmed some but not all of the a priori hypotheses. Importantly, significant variation was seen among individual primary care providers in Communication barriers perceived by their patients, but not in other subscales.

Conclusions: Psychometric analyses provide support for the reliability and validity of the Barriers to Care Instrument in a clinical sample. Confirmation in multi-site clinical samples, and in community-based samples, will provide further information on its utility.

Impact: This instrument may be useful in assessing perceived barriers to care in clinical and epidemiologic investigations, and in administrative monitoring of services (e.g., to assess the impact of administrative and clinical reorganizations).