Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population

Andrea N Garcia; Angela Venegas-Murrillo; Adrienne Martinez-Hollingsworth; Lisa V Smith; Kenneth Wells; MarySue V Heilemann; Lori Fischbach; Patricia L Cummings; Tony Kuo

doi:10.1007/s40615-023-01624-3

Patterns of Health Care Access and Use in an Urban American Indian and Alaska Native Population

J Racial Ethn Health Disparities. 2023 May 18:1-11. doi: 10.1007/s40615-023-01624-3. Online ahead of print.

Authors

Andrea N Garcia^{1

2}, Angela Venegas-Murrillo³, Adrienne Martinez-Hollingsworth⁴, Lisa V Smith⁵, Kenneth Wells⁶, MarySue V Heilemann⁷, Lori Fischbach⁸, Patricia L Cummings⁹, Tony Kuo¹⁰

Affiliations

¹ Los Angeles County Department of Mental Health, 510 S. Vermont Street, Los Angeles, CA, 90020, USA. acgarcia@dmh.lacounty.gov.
² County Department of Mental Health, National Clinician Scholars Program at the University of California, (UCLA); Los Angeles CA, Los Angeles, USA. acgarcia@dmh.lacounty.gov.
³ National Clinician Scholars Program at UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
⁴ National Clinician Scholars Program at UCLA, Los Angeles, CA, USA, Samuel Merritt University, Oakland, CA, USA.
⁵ Rapid Assessment, Training and Evaluation Unit - Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
⁶ Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine; Department of Health Policy and Management, UCLA Fielding School of Public Health, Center for Health Services and Society of the Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
⁷ UCLA School of Nursing, National Clinician Scholars Program at UCLA, Los Angeles, CA, USA.
⁸ Quality Assurance Team, COVID-19 Outbreak Management Branch, Los Angeles County Department of Public Health, Los Angeles, CA, USA.
⁹ Epidemiology Research & Evaluation, Eisenhower Medical Center, Rancho Mirage, CA, USA.
¹⁰ Department of Family Medicine, UCLA David Geffen School of Medicine; Department of Epidemiology, UCLA Fielding School of Public Health, Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA, USA.

Abstract

Studies of health care access and use among historically resilient populations, while common, often field a limited sample size and rarely ask the groups most impacted by health inequities to weigh in. This is especially so for research and programs that focus on the American Indian and Alaska Native (AIAN) population. The present study addresses this gap by examining data from a cross-sectional survey of AIANs in Los Angeles County. To better interpret project findings and generate culturally relevant contexts, qualitative feedback was gathered at a community forum held in Spring 2018. Because recruitment of AIANs has historically been challenging, purposive sampling was employed to strategically identify a larger eligible pool. Among those who were eligible, 94% completed the survey (n = 496). AIANs who were enrolled in a tribe were 32% more likely to use the Indian Health Service (IHS), compared with those who were not enrolled (95% CI: 20.4%, 43.2%; p < .0001). In multivariable modeling, the strongest factors influencing IHS access and use were: tribal enrollment, preference for culturally-specific health care, proximity of the services to home or work, having Medicaid, and having less than a high school education. Feedback from the community forum indicated cost and trust (of a provider) were important considerations for most AIANs. Study findings reveal heterogeneous patterns of health care access and use in this population, suggesting a need to further improve the continuity, stability, and the image of AIANs' usual sources of care (e.g., IHS, community clinics).

Keywords: Access to care; American Indian and Alaska Native population; Health care use; Indian Health Service; Patient preference.