Said A Ibrahim, MD, MPH Louis Stokes Dept VAMC & CWRU, Cleveland, OH; Christopher Burant, MS, Louis Stokes Dept VAMC & CWRU, Cleveland, OH; Laura A. Siminoff, PhD, Louis Stokes Dept VAMC & CWRU, Cleveland, OH; C Kent Kwoh, MD, University of Pittsburgh Medical Center, Pittsburgh PA

Objectives: Access to medical care is an important determinant of health outcomes, and a major factor in observed ethnic disparities in health care outcomes. Perceptions of access to care have also been found to impact utilization. Previously, veterans from ethnic minorities have been reported as perceiving that their access to the VA health care system was not the same as that accorded to white veterans. As part of its community-based outpatient clinics initiative, the VA system has recently made significant changes to improve access to all veterans. The impact of these changes on the perceptions of access to care among ethnic minorities is not well understood. We used data from a recent VA study of racial/cultural variations in the management of osteoarthritis to examine elderly African American (AA) and white VA primary care patients regarding their perceptions of access to care.

Methods: 486 AA (46%) and white (54%) patients (age >50) attending VA primary care clinics in Cleveland, Ohio were randomly recruited for this study. Patients were asked "Overall, how difficult is it for you to get medical care when you need it?" Responses were dichotomized into "not at all difficult" vs. "difficult." In addition, patients were asked regarding their confidence in their primary physician, " to what extent do you have confidence in your primary physician." Response categories were "not at all; a tittle; somewhat; quite a bit; and very much." Information on potential confounders such as demographics, SES, comorbidity, and access to non-VA care/supplemental insurance were also acquired for multivariate analysis.

Results: AA and white patients in this cohort were comparable with respect to age (66 ± 10 vs. 66 ± 9, p= 0.60), disease burden (Charlson score 2.3 +/- 2 vs 2.5 +/- 2, P= 0.29), geriatric depression scores (4.4 +/- 3.3 vs. 4.9 +/- 3.8, p=0.08), and living arrangements (Living alone 37% vs. 30%, p=0.26). However, AAs were more likely to report lower annul household income (less than $10,000, 40% vs. 21%, p=0.000), employment (9% vs. 15%, P= 0.03), educational level (less than high school, 42.9% vs 29.4%, P= 0.002). 81% of AAs and 72% of whites responded "no difficulty" about access to medical care (p= 0.19). Equal numbers responded "no difficulty" about access to non-VA medical care (48 vs 48%; p= 0.95). However, only 58% of AAs had supplemental non-VA health insurance, compared to 74% of whites (P= 0.000). The adjusted odds ratio for AA/white differences in response to questions on access to medical care was 0.52 (95% CI 0.32 to 0.84; P= 0.008). Regarding confidence in primary physician, 41% of AAs and 46% of whites responded " very much" to this question. Overall, differences in response between AAs and whites to this question were not statistically significant (P= 0.35).

Conclusions: In this sample of elderly, male, primary care patients, AAs were less likely than whites to perceive "difficulty" with access to medical care. They were equally likely to perceive "no difficulty" with non-VA care, and their confidence in their primary physician was comparable to that expressed by whites. However, AA patients were much less likely than whites to report have non-VA insurance.

Impact: Improving access to care for all veterans is a VA priority. Understanding the existence and reasons behind perceived barriers to access to care may help the VA improve access for all veterans. Our results suggest that progress had been made in reaching out to African-American veterans, but must be replicated in other settings, demographic groups, and regions.