Access to care by health center patients with chronic conditions

Introduction/Purpose: Health Centers are serving a growing number of patients with multiple chronic conditions (MCC). These numbers are anticipated to continue growing as a result of an aging U.S. population. Patients with MCC typically have more health care needs. In order to explore potentially unique needs of patients with MCC, this study compared the characteristics of patients with and without chronic conditions as well as assessing access to care and satisfaction with care received among patients with and without chronic conditions.

Methods: Data for this study were from the 2009 Health Center Patient Survey, a nationally representative survey sponsored by the Health Resources and Services Administration (HRSA). The dependent variables included five measures of access to care and satisfaction with care such as unable to get or delayed in getting needed medical are, unable to get or delayed in getting needed dental care, unable to get or delayed in getting mental care, unable to get or delayed in getting needed prescription medicines, and overall satisfaction with care received. The main independent variable was chronic conditions categorized into zero, one, and at least two chronic conditions. Race/ethnicity, insurance status, as well as other patient characteristics, were also included as covariates. Descriptive analysis summarized the characteristics of patients with and without chronic conditions. Bivariate analysis and multiple logistic regressions were conducted to compare access to care among the three groups of health center patients.

Findings: Most health center patients had more than one chronic condition. After controlling for patient characteristics, those with chronic conditions had significantly higher odds of reporting access barriers than those without chronic conditions while patients with multiple conditions were the most likely to have access barriers. Uninsured patients also had significantly higher odds of reporting access barriers than insured patients. However, no statistically significant differences were found in overall satisfaction with care between patients with and without chronic conditions. In addition, after controlling for other factors, health care disparities between non-Hispanic Whites and their minority counterparts were eliminated. 

Conclusion: The needs of health center patients with chronic conditions are different from those without. Our findings suggest more attention is warranted, both at the policy and practice levels, to ensure responsiveness to the needs of patients with chronic conditions.