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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1190 — Examining Equity on Access to Care and Care Coordination Measures of Sexual Minority Veterans Utilizing the Veterans Health Administration

Lead/Presenter: Shane Lamba,  Office of Health Equity
All Authors: Lamba S (Office of Health Equity), Grozdanic T (Office of Health Equity) Moy E (Office of Health Equity) Jones KT (Office of Health Equity)

Objectives:
Access to health care and continuity of care are pressing public health issues for sexual and gender minority (SGM) people. Specifically, sexual minority Veterans (SMV) (also referred to as lesbian, gay, or bisexual) have reported less favorable health care experiences while utilizing medical care across the Veterans Health Administration (VHA). To better understand the current state of access and care coordination outcomes for SMVs, we examined differences by sexual minority status with the access and care coordination domains from the 2020 Survey for Healthcare Experiences (SHEP)-Primary Care Medical Home (PCMH).

Methods:
The 2020 SHEP-PCMH data were compiled from the VHA administrative database. We used several measures from the access and care coordination domains. Responses were dichotomized to ‘Always vs. Less’ and stratified by sexual minority status. There were two cohorts of interest in this study. Veterans who self-identified as “Gay”, “Lesbian”, “Bisexual”, “Other” or “I’m not sure” were grouped together as a sexual minority Veteran. And individuals who selected “Heterosexual or Straight” were the referent. Therefore, the final analytic sample included n = 68,348 respondents, of which 2.9% identified as a sexual minority Veteran. Descriptive statistics, chi-squared tests, and t-tests were performed on categorial and continuous variables. Logistic regression coefficients were represented as adjusted odds ratios (aORs). Covariates were age, race/ethnicity, education, and biological sex. Alpha was set at 0.05.

Results:
Relative to heterosexual Veterans, SMVs were significantly older (70.5 years vs. 67.8 years, p < 0.0001), were more likely to be a woman (16.0% vs. 5.6%), Black/African American (10.5% vs. 8.2%), Latino (8.5% vs. 5.6%), and have more than a 4-year degree (13.3% vs. 11.8%) (all p < 0.0001). Compared to heterosexual Veterans, SMVs were less likely to report receiving a routine/check-up appointment as soon as needed (aOR 0.83; 95% CI: 0.73, 0.94) and seeing their provider within 15 minutes of their appointment time (aOR 0.79; 95% CI: 0.66, 0.94). Additionally, SMVs were less likely to report having discussed prescription medicines taken (aOR 0.83; 95% CI: 0.75, 0.92), reasons for a desire to take a medication (aOR 0.83; 95% CI: 0.72, 0.96), and having follow-up discussions after an ordered blood test, x-ray, or other medical tests (aOR 0.78; 95% CI: 0.69, 0.88).

Implications:
We found that SMVs experienced significant access and care coordination issues when seeking VHA care compared to their heterosexual counterparts. Sexual minority status was also associated with less positive experiences of coordinated care.

Impacts:
This is the first study to stratify access to care and care coordination data by sexual orientation and/or gender identity. Therefore, these findings support the need for VHA to focus on equitable programmatic changes to improve appointment availability and streamline follow-up care for SMVs.