Differential patterns of healthcare use by Hispanic and NHW elders provide information about disparities in access, cultural norms, and appropriateness of care. This cross-sectional study compared utilization among 1,433 rural Coloradan Hispanic and NHW SLVHAS participants aged 60 and older. Age- and sex-adjusted results indicated significantly less Hispanic use of nursing homes (OR 0.5; 95% CI 0.3, 0.8) and greater use of professional home nursing services (OR 3.6, 95% CI 2.1, 6.0), but no ethnic differences in outpatient care or hospitalization. Hispanic study participants were significantly younger, had less education and income, more often reported transportation as a barrier to care, had fewer comorbidities and more IADL dependence, reported poorer self-assessed health, and had lower cognitive status scores. Logistic regression analyses based on the behavior model of utilization found use strongly associated with need factors: outpatient care correlated with disease burden (OR 1.4; 95% CI 1.3, 1.5) and IADL dependence (OR 1.4; 95% CI 1.1, 2.0); home nursing care with ADL dependence (OR 4.7; 95% CI 2.3, 9.8) and IADL dependence (OR 3.1; 95% CI 1.4, 6.6); and nursing home use with ADL dependence (OR 12.1; 95% CI 4.6, 31.9) and cognitive impairment (OR 8.6; 95% CI 3.3, 22.5). Predisposing characteristics (age, marital status, education) and enabling characteristics (public insurance, availability of no- or low-cost care, transportation difficulties) also influenced utilization. Controlling for these important characteristics, however, did not change the differential ethnic pattern of nursing home use (OR 0.4; 95% CI 0.2, 0.8), which likely reflects different cultural norms.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to: 1. Describe rural ethnic (Hispanic vs. non-Hispanic white) differences in health care utilization. 2. Assess the degree to which various need, predisposing, and enabling factors associate with utilization patterns. 3. Apply the behavioral model of utilization to a specific set of utilization data
Keywords: Utilization, Hispanic
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.