1042 — Misconceptions about Racial Healthcare Disparities May Prevent Providers from Perceiving Disparities in VA

Burgess DJ, Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System and University of Minnesota; Gollust SE, University of Minnesota; Bokhour BG, Center for Healthcare Organization and Implementation Research and Boston University; Cunningham B, University of Minnesota; Gordon HS, Jesse Brown VAMC, Center of Innovation in Complex Chronic Healthcare, and University of Illinois at Chicago; Jones D, University of Minnesota; Saha S, Center to Improve Veteran Involvement in Care, VA Portland Health Care System and Oregon Health & Science University; Do T, Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System; Pope C, COIN/ Health Equity & Research Outreach Innovation Center (HEROIC) , Ralph H. Johnson VAMC;

Objectives:
Racial disparities have been documented within and outside VA. There is consensus that providers play a key role in eliminating disparities. This qualitative analysis examines VA providers' beliefs about racial healthcare disparities to provide guidance for the development of disparity-reduction strategies.

Methods:
We conducted individual semi-structured interviews with 39 physicians and 14 nurse practitioners/physician assistants in three VA facilities. The majority of providers (89%) identified as white. Interviews were analyzed using grounded thematic analysis.

Results:
Providers varied in their beliefs about the existence and causes of racial healthcare disparities. Some providers endorsed the existence of disparities and that provider bias played a role. Others endorsed the existence of disparities in the US but believed that disparities were rare or non-existent in VA and that VA providers were unlikely to perpetuate bias. Several misconceptions about disparities appeared to contribute to this perception. First, some providers believed that disparities are primarily due to lack of health insurance and limited access to care, and that disparities in VA were rare because of the lack of financial barriers. Second, some providers did not recognize that racial bias could be unconscious rather than overt and believed disparities were rare because they did not witness explicit racial discrimination. Third, some providers acknowledged patient mistrust as a contributor to disparities but attributed it to historical instances of racism (e.g., Tuskegee), dismissing the possibility of ongoing discrimination in health care. Finally, providers who acknowledged disparities often highlighted non-race-based reasons for differences in care, including patient factors such as non-adherence to medication, mental illness, and cultural beliefs. Providers frequently focused on solutions to improve healthcare quality overall rather than those targeted specifically towards disparities reduction.

Implications:
A number of providers saw disparities as something that primarily occurs outside VA and believed that VA providers were unlikely to contribute to them.

Impacts:
Eliminating disparities requires that providers are aware that disparities exist in VA and their own potential to contribute to or reduce them. Yet there exist several misconceptions about disparities that may prevent this recognition. Specific training strategies to address these misconceptions are needed to successfully engage providers in disparity-reduction efforts.