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性取向对退伍军人利用退伍军人健康管理局初级保健服务的以患者为中心的护理结果的影响。

Differences by Sexual Orientation in Patient-Centered Care Outcomes for Veterans Utilizing Primary Care Services at the Veterans Health Administration.

机构信息

VA Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA.

出版信息

LGBT Health. 2024 Aug-Sep;11(6):455-464. doi: 10.1089/lgbt.2023.0224. Epub 2024 Mar 2.

DOI:10.1089/lgbt.2023.0224
PMID:38837356
Abstract

This study examined the differences by sexual orientation in patient-centered care outcomes (including health care experiences and health-related screening) of veterans utilizing Veterans Health Administration (VHA) primary care. VHA's adapted version of the Consumer Assessment of Healthcare Providers and Systems was used to compare the health care experience of primary care services among sexual minority (SM) and heterosexual veterans. Health care experience measures were dichotomized to "always" versus "less" and stratified by SM status. Health-related screening measures were dichotomous. Survey data were weighted using provided sample weights. Descriptive statistics were performed on sociodemographic characteristics. Logistic regression coefficients were represented as adjusted odds ratios (aORs). A total of 66,348 veterans were included in the analytic sample, of which 2.9% ( = 1,935) identified as SM. Sexual orientation was ascertained by self-report measures by veterans. SM veterans were significantly younger (56.95 years vs. 63.43 years,  < 0.001), were less likely to report that their provider showed respect for what they had to say (aOR: 0.76; 95% confidence interval [CI]: 0.61-0.95), that they were asked about difficulties taking care of their health (aOR: 0.81; 95% CI: 0.67-0.96), and their provider listened carefully to them (aOR: 0.71; 95% CI: 0.57-0.87) compared to heterosexual veterans. Health care experiences differed between SM and heterosexual veterans who sought VHA primary care, suggesting the need to increase provider trainings, which may improve cultural competency and promote a more welcoming and inclusive environment.

摘要

这项研究考察了利用退伍军人事务部 (VHA) 初级保健的退伍军人中,性取向对患者为中心的护理结果 (包括医疗保健体验和与健康相关的筛查) 的差异。VHA 使用经过调整的医疗保健提供者和系统消费者评估版本,比较了性少数群体 (SM) 和异性恋退伍军人的初级保健服务的医疗保健体验。将医疗保健体验措施分为“始终”和“较少”,并按 SM 状态分层。与健康相关的筛查措施为二分法。使用提供的样本权重对调查数据进行加权。对社会人口统计学特征进行描述性统计。逻辑回归系数表示为调整后的优势比 (aOR)。在分析样本中共有 66348 名退伍军人,其中 2.9% ( = 1935) 自我报告为 SM。性取向通过退伍军人的自我报告措施确定。SM 退伍军人明显更年轻 (56.95 岁 vs. 63.43 岁, < 0.001),更不可能报告他们的提供者尊重他们所说的话 (aOR: 0.76;95%置信区间 [CI]: 0.61-0.95),他们被问到照顾自己健康的困难 (aOR: 0.81;95% CI: 0.67-0.96),他们的提供者认真倾听他们的意见 (aOR: 0.71;95% CI: 0.57-0.87),与异性恋退伍军人相比。寻求 VHA 初级保健的 SM 和异性恋退伍军人之间的医疗保健体验存在差异,这表明需要增加提供者培训,这可能会提高文化能力,并促进更欢迎和包容的环境。

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