VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center.
Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT.
Med Care. 2021 Jun 1;59(Suppl 3):S322-S326. doi: 10.1097/MLR.0000000000001551.
On April 23, 2014, US media outlets broadcast reports of excessive wait times and "secret" waitlists at some Veterans Affairs (VA) hospitals, precipitating legislation to increase Veterans' access to private sector health care.
The aims were to assess changes in Veterans' distrust in the VA health care system before and after the media coverage and explore sex and racial/ethnic differences in the temporal patterns.
Veterans completed semistructured interviews on health care satisfaction from June 2013 to January 2015, including a validated scale of health system distrust (range: 1-5). We used linear splines with knots at 90-day intervals to assess changes in distrust before and after April 23, 2014 ("day 0") in linear mixed models. To explore sex and racial/ethnic differences in temporal patterns, we stratified models by sex and tested for interactions of race/ethnicity with time.
For women (n=600), distrust scores (mean=2.09) increased by 0.45 in days 0-90 (P<0.01), then decreased by 0.45 in days 90-180 (P<0.01). Among men (n=575), distrust scores (mean=2.05) increased by 0.18 in days 0-90 (P=0.059). Distrust levels were significantly higher for Black versus White women (time adjusted mean difference=0.21) and for Black and Hispanic versus White men (differences=0.26 and 0.18). However, the temporal patterns did not vary by race/ethnicity for women or men (interaction P=0.85 and 0.21, respectively).
Health system distrust increased in women following media coverage of VA access problems and was higher in Black/Hispanic versus White Veterans at all time periods. Such perceptions could influence Veteran decisions to seek health care in the community rather than VA.
2014 年 4 月 23 日，美国媒体报道了退伍军人事务部（VA）医院存在过长的等待时间和“秘密”候补名单的情况，这促使立法增加退伍军人获得私营部门医疗保健的机会。
评估在媒体报道前后退伍军人对 VA 医疗保健系统的不信任程度的变化，并探讨性别和种族/族裔差异在时间模式中的表现。
退伍军人于 2013 年 6 月至 2015 年 1 月期间完成了关于医疗保健满意度的半结构化访谈，其中包括一个经过验证的医疗系统不信任度量表（范围：1-5）。我们使用线性样条，在 90 天的间隔处设置节点，在线性混合模型中评估 2014 年 4 月 23 日（“第 0 天”）前后不信任程度的变化。为了探索性别和种族/族裔差异在时间模式中的表现，我们按性别分层模型，并检验种族/族裔与时间的交互作用。
对于女性（n=600），不信任得分（均值=2.09）在第 0-90 天增加了 0.45（P<0.01），然后在第 90-180 天减少了 0.45（P<0.01）。对于男性（n=575），不信任得分（均值=2.05）在第 0-90 天增加了 0.18（P=0.059）。黑人女性的不信任水平明显高于白人女性（时间调整后的平均差异=0.21），黑人男性和西班牙裔男性的不信任水平也明显高于白人男性（差异分别为 0.26 和 0.18）。然而，对于女性或男性，种族/族裔差异并没有改变时间模式（交互 P 值分别为 0.85 和 0.21）。
在 VA 获得医疗保健问题的媒体报道后，女性的医疗系统不信任度增加，而且在所有时间段内，黑人/西班牙裔退伍军人的不信任度都高于白人退伍军人。这种看法可能会影响退伍军人在社区而不是在 VA 寻求医疗保健的决策。
