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Binational utilization and barriers to care among Mexican American border residents with diabetes

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Date
2013
Author
de Heer, Hendrik D.
Salinas, Jennifer
Lapeyrouse, Lisa M.
Heyman, Josiah
Morera, Osvaldo F.
Balcazar, Hector G.
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Abstract
OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.(AU)
 
OBJETIVO: Evaluar si las personas con diabetes que residen en la frontera mexicano-estadounidense 1) encuentran mayores barreras para obtener atención médica en los Estados Unidos de América que en México; y 2) acuden a México en busca de atención y medicación con mayor probabilidad que las personas no diabéticas que residen en la frontera. MÉTODOS: Durante el 2009 y el 2010, en una muestra de 1 002 hogares mexicano-estadounidenses, se llevó a cabo una encuesta transversal de salud en dos etapas, estratificada y aleatorizada. RESULTADOS: Las tasas de diabetes eran elevadas (15,4%). La mayor parte de las personas con diabetes (86%) notificaron comorbilidades. En comparación con los participantes no diabéticos, los afectados de diabetes experimentaban dificultades algo mayores para pagar US$ 25 (P = 0,002) o US$ 100 (P = 0,016) por recibir atención médica, y encontraban mayores barreras en materia de transporte e idioma (P = 0,011 y 0,014, respectivamente) para ser atendidos en los Estados Unidos, aunque era más probable que contaran con una persona o lugar adonde acudir en busca de atención médica y para ser sometidos a tamizaje. Una cuarta parte de los participantes acudían a México en busca de atención o medicamentos. Una edad menor y el haber vivido en México se asociaban con la búsqueda de atención en México, pero no el padecer diabetes. La presencia de múltiples barreras financieras se asociaba independientemente con una probabilidad aproximadamente tres veces mayor de acudir a México en busca de atención médica o medicación. Las barreras idiomáticas se asociaban con la búsqueda de atención en México. La confusión acerca de los trámites para recibir atención médica y la percepción de no recibir siempre un trato respetuoso por parte de los proveedores de atención médica en los Estados Unidos se asociaban con la búsqueda de atención y medicación en México (odds ratio, 1,70 - 2,76). CONCLUSIONES: La notificación de barreras modificables a la atención médica fue frecuente entre los participantes y algo más frecuente entre 1) las personas con diabetes; y 2) los que buscaban se atendidos en México. Sin embargo, estos fenómenos son estadísticamente independientes; no era más probable que las personas con diabetes utilizaran servicios en México. Ambos conjuntos de problemas (las barreras que deben afrontar las personas con diabetes, las barreras relacionadas con el uso de servicios en México) pueden coexistir, y proporcionan oportunidades para mejorar el acceso a la atención y el tratamiento de las enfermedades.(AU)
 
Series
Rev Panam Salud Publica;34(3),sept. 2013
Subject
Hispanic Americans; Mexican Americans; Diabetes Mellitus; Border Areas; Border health; Texas; Mexico; United States; Hispanoamericanos; Americanos Mexicanos; Diabetes Mellitus; Areas Fronterizas; Salud fronteriza; Texas; Mexico; Estados Unidos; Diabetes Mellitus; Turismo Médico; Americanos Mexicanos; Aceitação pelo Paciente de Cuidados de Saúde; Barreiras de Comunicação; Comorbidade; Estudos Transversais; Diabetes Mellitus; Diabetes Mellitus; Migração Internacional; Acesso aos Serviços de Saúde; Inquéritos Epidemiológicos; Renda; Cobertura do Seguro; Linguagem; Indigência Médica; Turismo Médico; Americanos Mexicanos; Americanos Mexicanos; Mexico; Mexico; Aceitação pelo Paciente de Cuidados de Saúde; Pobreza; Amostragem; Texas; Transportes
URI
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892013000900001
https://iris.paho.org/handle/10665.2/9139
Citation
de Heer, Hendrik D.,Salinas, Jennifer,Lapeyrouse, Lisa M.,Heyman, Josiah,Morera, Osvaldo F.,Balcazar, Hector G. (2013) Binational utilization and barriers to care among Mexican American border residents with diabetes. Rev Panam Salud Publica;34(3) 147-154,sep. 2013. Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892013000900001
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