Health care experiences and health status of African-American veterans

African-American veterans of the armed forces often struggle to get the health care they need, says a new report from Northeastern University's Institute on Urban Health Research (IUHR).

The report, titled “Health Care Experiences and Health Status of African-American Veterans” was partially funded by the Boston Public Health Commission (BHPC) and the IUHR and was prepared in response to a request from the Tri Ad Veterans League, Inc., a Boston-based grassroots group of African-American veterans.

Among the findings, Northeastern researchers reported that 78% of the respondents recalled having an experience of discrimination where they received health care services. Although on average, study participants were moderately satisfied with their health care, they indicated lack of confidence in the diagnosis given to them by their doctors. They also expressed dissatisfaction with access to medical specialists; the time their doctors spent with them; and getting medical care in a timely manner.

“Our study uncovered significant relationships between perceived discrimination from health care providers and the satisfaction with care in general,” says Nathaniel M. Rickles, Pharm.D., Ph.D., BCPP, assistant professor of pharmacy at Northeastern and lead author of the report. “We also found that there is a strong connection between perceived discrimination and the level of physical functioning of our respondents, which may be due to a delay in getting the services they need.”

Additional findings include:

• About two-thirds of the sample did not use VA as their sole provider, although only about 10% indicated a lack of willingness to use the VA in the future. The authors note that this indicates that the decision not to use VA services may have less to do with dissatisfaction with the VA system and more with their access to other sources of health care.
• Many respondents expressed concern about their health care providers not asking them about their spiritual needs. The authors recommend future research to explore ways for VA providers to integrate chaplain services with medical care so African-American patients feel their spiritual needs are being met holistically by the medical team.

The report concludes that further research needs to be done to assess discrimination in health care of veterans. Recommendations of Joseph D. Warren, Ph.D. of Northeastern University's Office of Public Affairs and one of the authors of the report, include:

• Health care systems serving veterans, especially the VA, should solicit the assistance of veteran's advocacy groups, like the Tri Ad Veterans, to monitor and assist the VA to address identifiable disparities with access, patient satisfaction and quality of care.
• A comprehensive review and ongoing performance-based monitoring of policies and provider behavior is needed, as well as further education of administrators and service providers about health disparities, unconscious clinician bias and cultural competency.
• Policy changes and provider-level interventions are needed to reduce discrimination in health care.

“The effectiveness of our mission largely depends upon academic institutions, like Northeastern University, providing the intellectual and scientific background to our work,” says Haywood Fennell, founder of the Tri Ad Veterans League, Inc. “We are committed to providing the leadership to mobilize the necessary resources to implement the recommendations for future study.”