Racial and Ethnic Differences in Primary Care Experiences for Veterans with Mental Health and Substance Use Disorders
BACKGROUND:
Primary care is often the first step in treatment for Veterans with a mental health or substance use disorder (MHSUD). How persons with MHSUDs experience care in Patient-Centered Medical Homes (PCMHs) is unknown. This study examined racial and ethnic differences in positive and negative experiences in VA PCMH settings among 65,930 Veterans with MHSUDs who completed VA's 2013 PCMH Survey of Healthcare Experiences of Patients. This included ratings across 7 domains: access, communication, office staff helpfulness/courtesy, provider ratings, comprehensiveness, medication shared decision-making, and self-management support. Study participants were 67% White, 20% Black, 11% Hispanic, 1% American Indian/Alaska Native (AI/AN), and 1% Asian/Pacific Islander (A/PI).
FINDINGS:
- In this large sample of Veterans with MHSUDs, positive experiences were reported least often for access (22%). Negative experiences were reported most often for self-management support (30%) and comprehensiveness (16%), defined as provider attention to MHSUD concerns.
- One or more racial/ethnic minority groups reported more negative and/or fewer positive experiences than Whites in the following 4 domains:
- Access: Black and Hispanic Veterans reported more negative and fewer positive experiences. AI/AN Veterans also reported more negative experiences.
- Communication: AI/AN and A/PI Veterans reported more negative and/or fewer positive experiences.
- Office Staff Helpfulness/Courtesy: Hispanic Veterans reported fewer positive experiences. AI/AN and A/PI Veterans reported more negative experiences.
- Comprehensiveness: Hispanic Veterans reported more negative experiences, while Black Veterans reported more positive experiences.
IMPLICATIONS:
- Solutions are needed to improve access to care for all Veterans with MHSUDs, with additional attention on improving access for Black, Hispanic, and AI/AN Veterans.
- Interventions to reduce racial/ethnic disparities in patient experiences should also target providers' communication skills and attention to MHSUD concerns, and office staff helpfulness and courtesy.
LIMITATIONS:
- Small numbers of AI/AN and A/PI Veterans limited statistical power for these groups.
- Analyses were limited to individuals already enrolled in and using VA services.
- Identifying MHSUDs using diagnostic codes may have missed some patients.
AUTHOR/FUNDING INFORMATION:
Drs. Jones, Mor, Cashy, Gordon, and Hausmann are part of HSR&D's Center for Health Equity Research & Promotion (CHERP) in Pittsburgh and Philadelphia, PA.
Jones A, Mor M, Cashy J, Gordon A, Haas G, Schaefer J, and Hausmann L. Racial/Ethnic Differences in Primary Care Experiences in Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders. Journal of General Internal Medicine. June 20, 2016;e-pub ahead of print.
