(PS1-B36) Four Modifiable Variables That Predict Problems with Healthcare Utilization in People with Hypertension

There is a need to understand why people with chronic medical conditions sometimes have problems utilizing healthcare. Five key healthcare utilization problems include failing to obtain routine care, failing to seek care when needed, failing to fill prescriptions, missing scheduled appointments, and using emergency rooms instead of primary care. These problems may be especially detrimental to the health of people with chronic conditions, such as hypertension. To understand these problems, it is valuable to consider four key variables expected to predict healthcare utilization, including barriers to access, patient attitudes of medical mistrust, patient-practitioner alliance, and patient confusion over medical information. These four predictor variables are suggested by recent psychometric research and recent research identifying dimensions of patient-practitioner relationships. Moreover, they are classified by Anderson’s behavioral model of access to care as being types of enabling resources and health beliefs, which are presumed to be modifiable variables that are especially important potential targets for intervention research.

To clarify the relative importance of these variables in a medical population, a sample of 856 people with hypertension were recruited via marketing research panels to complete an online survey with scales assessing the five healthcare utilization problems and the four predictor variables (as listed above), along with a measure of general health. Recruitment procedures targeted specific demographic groups, producing a sample that was 47% Black and 53% White, and 46% low income and 54% not low income. In a series of regression analyses, each healthcare utilization variable was predicted using the four predictor variables along with race, income, and general health. Results were especially robust for predictor variables of patient confusion and barriers to access. These two variables each explained unique variance in four of the five healthcare utilization problems with results remaining significant after controlling for effects of all the other predictors and control variables. In contrast, patient-practitioner alliance and medical mistrust each explained significant unique variance in only one utilization problem. These results suggest that patient confusion and barriers to access may be more important than patient alliance and mistrust in explaining healthcare utilization problems, and therefore might be especially valuable variables to consider in future intervention research.