Julian Brunner1, Danielle E Rose2, Emmeline Chuang3, Ismelda Canelo4, Elizabeth M Yano5. 1. HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System, 16111 Plummer St, Sepulveda, CA, 91343, Building 25, USA. Electronic address: julian.brunner@va.gov. 2. HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System, 16111 Plummer St, Sepulveda, CA, 91343, Building 25, USA. Electronic address: danielle.rose@va.gov. 3. Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, 650 Charles Young Dr. S, 31-269 CHS Box 951772, Los Angeles, CA, 90095, USA. Electronic address: emchuang@g.ucla.edu. 4. HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System, 16111 Plummer St, Sepulveda, CA, 91343, Building 25, USA. Electronic address: ismelda.canelo@va.gov. 5. HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System, 16111 Plummer St, Sepulveda, CA, 91343, Building 25, USA; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, 650 Charles Young Dr. S, 31-269 CHS Box 951772, Los Angeles, CA, 90095, USA. Electronic address: elizabeth.yano@va.gov.
Abstract
BACKGROUND: Several factors besides appointment availability can influence access to care. Among these factors are the diverse challenges that patients may experience in navigating the healthcare system. However, the relationship between these challenges or "hassles" and delaying or forgoing care has not been assessed. METHODS: We examined the relationship between healthcare system hassles and delaying or forgoing needed care. We used data from a 2016 Veterans Affairs (VA) survey of women veterans (N = 821) who were active users of primary care (3+ primary care visits in the past year) at any of 12 VA medical centers. The main independent variable was a measure of 16 healthcare system hassles, encompassing a wide range of clinically-relevant aspects of patient experience, such as uncertainty about when/how to take a medication or difficulty getting questions answered between appointments. The outcome was a self-reported measure of delaying or forgoing needed care. We used logistic regression to estimate this outcome as a function of hassles, adjusting for age, comorbidities, and health care utilization. Survey weights accounted for within-site clustering, nonproportional sampling, and nonresponse. RESULTS: Overall, 26% of participants reported 0 hassles, and 39% reported 4 or more. Reporting 4 or more hassles (vs. 0) was associated with a roughly 5-fold increase in the predicted probability of delaying or forgoing care. CONCLUSION: Addressing healthcare system hassles could yield unexpected benefits to realized access. Published by Elsevier Inc.
BACKGROUND: Several factors besides appointment availability can influence access to care. Among these factors are the diverse challenges that patients may experience in navigating the healthcare system. However, the relationship between these challenges or "hassles" and delaying or forgoing care has not been assessed. METHODS: We examined the relationship between healthcare system hassles and delaying or forgoing needed care. We used data from a 2016 Veterans Affairs (VA) survey of women veterans (N = 821) who were active users of primary care (3+ primary care visits in the past year) at any of 12 VA medical centers. The main independent variable was a measure of 16 healthcare system hassles, encompassing a wide range of clinically-relevant aspects of patient experience, such as uncertainty about when/how to take a medication or difficulty getting questions answered between appointments. The outcome was a self-reported measure of delaying or forgoing needed care. We used logistic regression to estimate this outcome as a function of hassles, adjusting for age, comorbidities, and health care utilization. Survey weights accounted for within-site clustering, nonproportional sampling, and nonresponse. RESULTS: Overall, 26% of participants reported 0 hassles, and 39% reported 4 or more. Reporting 4 or more hassles (vs. 0) was associated with a roughly 5-fold increase in the predicted probability of delaying or forgoing care. CONCLUSION: Addressing healthcare system hassles could yield unexpected benefits to realized access. Published by Elsevier Inc.