title: Self-reported barriers to hemophilia care in people with factor VIII deficiency.
abstract: BACKGROUND
  In 1975, a national network of hemophilia treatment centers (HTCs) was created to increase access to healthcare services for individuals with hemophilia. Studies demonstrate that care in HTCs improves outcomes and reduces costs.
  
  
  OBJECTIVE
  The objective of the study was to assess the association of demographic, insurance, and clinical characteristics with self-reported barriers to HTC utilization.
  
  
  METHODS
  Data were collected from six HTCs from 2005 through 2007. Adult participants and parents of children aged <18 years were interviewed. Barriers were assessed by asking whether it was difficult to obtain care in the past 12 months. Chi-square test and logistic regression were used to assess factors associated with self-reported barriers to care. All analyses were performed in 2010-2011.
  
  
  RESULTS
  Data for 327 participants (50% adult, 64% severe hemophilia) were analyzed in 2010-2011. Most participants/parents did not report barriers to HTC utilization. However, 46 participants/parents (14%) reported one to six barriers, and 23 reported one barrier. Most frequently reported barriers were "distance to the clinic" for children (44%) and "insurance coverage" for adults (40%). Factors significantly associated with self-reported barriers were: lower income (<$20,000; OR=3.11, 95% CI=1.14-8.45), difficulty finding insurance or obtaining full-year coverage (OR=5.71, 95% CI=2.63-12.41), and decreased state Medicaid coverage for low-income, non-elderly individuals (OR=0.93, 95% CI=0.89-0.98).
  
  
  CONCLUSIONS
  This study indicates that, although few people with hemophilia have barriers to care at HTCs, those with lower income, difficulty finding or maintaining adequate insurance coverage, or living in states with lower Medicaid generosity are more likely to report barriers. Identifying and resolving such barriers may improve care access and patient-reported outcomes.
authors.affiliation: Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Zheng-Yi
authors.initials: ZY
authors.lastname: Zhou
authors.forename: Brenda
authors.initials: B
authors.lastname: Riske
authors.forename: Ann D
authors.initials: AD
authors.lastname: Forsberg
authors.forename: Megan
authors.initials: M
authors.lastname: Ullman
authors.forename: Judith R
authors.initials: JR
authors.lastname: Baker
authors.forename: Marion A
authors.initials: MA
authors.lastname: Koerper
authors.forename: Randall G
authors.initials: RG
authors.lastname: Curtis
authors.forename: Mimi
authors.initials: M
authors.lastname: Lou
authors.forename: Wu
authors.initials: W
authors.lastname: Joanne
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002648:Child; D006297:Health Services Accessibility; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D057566:Self Report; D014481:United States; D055815:Young Adult