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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1200 — Assessing Equity on Patient Centered Care Outcomes by Sexual Minority Status of Veterans Using Primary Care Across the VHA

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:
Patient centered care (PCC) is a central tenet of health care at the Veterans Health Administration (VHA). Studies show that sexual minority veterans (SMVs) have poorer health care experiences when compared to heterosexual veterans. In 2020, sexual orientation and gender identity measures were added to the VHA’s Survey for Healthcare Experiences (SHEP)-Primary Care Medical Home (PCMH). Using the 2020 SHEP-PCMH data, this study examines the differences in PCC measures between sexual minority Veterans and heterosexual Veterans.

Methods:
The SHEP-PCMH data were compiled from the VHA administrative database. We used fourteen PCC measures that 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 grouped into the reference group. Therefore, the final analytic sample included n = 68,348 respondents, of which 2.9% identified as a sexual minority. 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:
SMVs were significantly older (70.5 years vs. 67.8 years, p < 0.0001) when compared to heterosexual Veterans. Compared to heterosexual Veterans, SMVs were less likely to report that their provider always knew important information about their medical history (aOR: 0.83; 95% CI: 0.74, 0.92), showed respect for what they had to say (aOR: 0.71; 95% CI: 0.62, 0.81), had their specific health goals discussed (aOR: 0.84; 95% CI: 0.76, 0.94), that clerks and receptionists at their provider's office were always helpful (aOR: 0.79; 95% CI: 0.71, 0.88), that clerks and receptionists always treated them with courtesy and respect (aOR: 0.79; 95% CI: 0.71, 0.88), their provider's office asked them if there was a period of time when they felt sad, empty, or depressed (aOR: 0.71; 95% CI: 0.63, 0.80), their provider's office asked about things in their life that worry them or cause them stress (aOR: 0.84; 95% CI: 0.75, 0.93), and were asked if there is any difficulty managing their health (aOR: 0.84; 95% CI: 0.76, 0.94).

Implications:
There are significant differences in patient centered care by sexual minority status among Veterans seeking primary care across the VHA. Future work should consider continued provider education, and cultural sensitivity trainings that can improve the quality of primary care rendered for Veterans from sexual minority groups.

Impacts:
This is the first study to examine the differences between sexual minority Veterans and heterosexual Veterans with respect to health care experiences in primary care settings. Future work should continue to survey SMVs in order to tailor any programmatic changes for provider education.