Achieving a 5-star rating: Analysis of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores among patients undergoing elective colorectal operations

Effects of health educational and participatory consumer group interventions in improving food handling practices in regional director of health services area Kalutara, Sri Lanka: non-randomized controlled community trial

INTRODUCTION

Safe and nutritious food is the key to sustaining life and promoting good health. Unsafe food creates a vicious cycle of disease and malnutrition, particularly affecting infants, young children, the elderly, and the sick.

METHODS

The study consisted of two phases, a descriptive cross-sectional study, and an intervention study. Both studies were conducted in the Regional Director of Health Services area, Kalutara, Sri Lanka. The descriptive cross-sectional study [food handlers (n = 904), food establishments (n = 421)] was conducted with the objective of determining factors associated with food handling practices among food handlers and in food establishments. The interventional study was a three-arm non-randomized controlled community trial (n = 50 per arm) with interventions of a participatory consumer group, educational package group, and control group.

RESULTS

The food establishments assessment tool (FEAT) contained 11 domains including 75 items with more than a hundred assessment points with a guide to conduct an assessment of food handling. The descriptive cross-sectional study found that food handlers' knowledge of food handling practices of storing milk, fish, and meat and fast-food items containing fish and meat was very poor (96.6%). Visibility of the last place of processing inside the food establishments to consumers was inadequate (19.2%) and the absence of the above-mentioned factor was significantly associated with an unsatisfactory level of food handling score in food establishments (p = 0.03). The unsatisfactory level of food handling was significantly higher among food establishments with non-personal ownership (p = 0.005), a low number of notices issued by legal authorities (p = 0.02), dereliction of duty by owners/managers on supervising (p < 0.001) and lack of medical certification to food handlers (p < 0.0001). Participatory consumer group intervention and educational package interventions were effective in improving food handling practices in food establishments and among food handlers (p < 0.0001). Two independent sample analysis using the Mann-Whitney U test showed, the best improvement in food handling practices was by participatory consumer group intervention (p < 0.0001) and the second was educational package intervention (p < 0.0001).

CONCLUSIONS

Knowledge and practices of food handling among participants were poor. A participatory consumer group is more effective than an educational package on improving food handling practices both among food handlers and in food establishments.

Development of educational package and participatory consumer groups to improve food handling practices in food establishments in Sri Lanka

Objectives

Improper food handling contributes to many foodborne diseases and food outbreaks globally leading to witnessed morbidities and mortalities. The study aims to develop an educational package and participatory consumer groups to improve food handling practices among food handlers and in food establishments in the Regional Director of Health Services area, Kalutara, Sri Lanka.

Methods

The study developed an educational package and participatory consumer groups to improve the food handling practices among food handlers and in food establishments. The critical knowledge gaps were identified during the first component of this study, which was conducted as a descriptive study, and the findings were further discussed in the Focus Group Discussion. Posters, info sheets, and workshops were used for educational packages, and four consumer groups were formed. The second component of the study following the development of the interventions was continued as a three-arm, non-randomized controlled community trial for 4 months in the Regional Director of Health Services, Kalutara.

Results

The educational package for food handlers was introduced as a package of a workshop, info sheets, posters to display at workplaces, and short refresher training two weekly to direct good food handling practices in food establishments. Consumer groups were strengthened to exercise their legal rights on their purchases and the ratings showed improvements in the hygiene levels with repeated consecutive visits.

Conclusions

The novel educational package and participatory consumer groups are designed and implemented to improve food handling practices among food handlers and in food establishments.

Patient Satisfaction Scores After Cardiac Surgery: Should They Be Risk-Adjusted?

The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) is a survey tool that quantifies patient satisfaction after hospitalization. We sought to interrogate our HCAHPS results in order to identify any association between preoperative health, type of operation, and postoperative outcomes, with patient satisfaction after cardiac surgery. Of 12,572 patients who underwent cardiac surgery between December 2012 and December 2019, 2587 patients (20.6%) completed the HCAHPS survey. Patient satisfaction was quantified using HCAHPS responses, focused on 'top-box' rating in nursing care, physician care, hospital environment, and overall hospital rating, as primary endpoints. Multivariable logistic regression was used to identify those variables associated with top-box scores. Elevated patient risk, as measured by the Society of Thoracic Surgeons (STS) risk score in 2112 patients, was predictive of lower rates of top-box responses in nursing care (OR 0.963, P = 0.003), physician care (OR 0.96, P = 0.002), and overall hospital rating (OR 0.97, P = 0.007). Major postoperative complications were associated with lower patient satisfaction for nursing care (OR 0.67, P = 0.038), physician care (OR 0.59, P = 0.012), and overall hospital rating (OR 0.64, P = 0.035); length of stay ≥ 6 days was associated with increased patient satisfaction for nursing care (OR 1.45, P < 0.001). Increased preoperative risk and postoperative complications are associated with lower rates of top-box patient satisfaction scores after cardiac surgery. When assessing patient satisfaction after cardiac surgery, we suggest that a preoperative risk profile be considered.

Identifying service quality gaps between patients and providers in a Native American outpatient clinic

Background

Native American communities in Montana reservations have reported low-level satisfaction in health services. This research explored if the services provided at a Blackfeet Indian Reservation outpatient clinic were designed to meet patient expectations.

Methods

Staff and patient interviews and surveys allowed service expectations to be assessed according to the clinic’s ability to meet those expectations. A total of 48 patients and ten staff members (83% of the staff at this clinic) participated in the study voluntarily.

Results

We found a disconnect between what patients anticipate for care and what staff think they are anticipating. We also found a discontent between what staff believes patients need versus what the patients feel is needed.

Conclusions

These gaps combine to increase the breach between patient expectations and perceptions of their healthcare services. With better insight that captures what patients are looking for from a service, the potential to meet those needs increases, and patients feel that their voice is respected and valued.

Examining the Association Between Chaplain Care and Patient Experience

A developing body of evidence indicates that chaplain care is associated with higher levels of patient/family satisfaction with their hospital care. We examined the association between chaplain care and patient experience among patients at Rush University Medical Center in Chicago who responded to Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey survey items between 2011 and 2017. Information about chaplain care was taken from the inpatients’ electronic medical record. Our analyses included 11 741 patients, 26.5% of whom had received any chaplain care. Patients with lower self-rated health were more likely to have received chaplain care (P < .001). In bivariate analyses, chaplain care was associated with lower likelihood of reporting the highest score for 4 patient experience items (P < .001). In multi-variable models that adjusted for patient self-rated health and other factors, the association between chaplain care and the 4 patient experience items was nonsignificant. There was no effect modification for patient religious affiliation, self-rated health, or other demographic factors. The chaplain care-patient experience association may be more complex than has initially appeared, and further research is needed to help us better understand it.

Patient-related Factors and Perioperative Outcomes Are Associated with Self-Reported Hospital Rating after Spine Surgery

BACKGROUND

Since 2013, the Centers for Medicare & Medicaid Services has tied a portion of hospitals' annual reimbursement to patients' responses to the Hospital Consumer Assessment and Healthcare Providers and Systems (HCAHPS) survey, which is given to a random sample of inpatients after discharge. The most general question in the HCAHPS survey asks patients to rate their overall hospital experience on a scale of 0 to 10, with a score of 9 or 10 considered high, or "top-box." Previous work has suggested that HCAHPS responses, which are meant to be an objective measure of the quality of care delivered, may vary based on numerous patient factors. However, few studies to date have identified factors associated with HCAHPS scores among patients undergoing spine surgery, and those that have are largely restricted to surgery of the lumbar spine. Consequently, patient and perioperative factors associated with HCAHPS scores among patients receiving surgery across the spine have not been well elucidated.

QUESTIONS/PURPOSES

Among patients undergoing spine surgery, we asked if a "top-box" rating on the overall hospital experience question on the HCAHPS survey was associated with (1) patient-related factors present before admission; (2) surgical variables related to the procedure; and/or (3) 30-day perioperative outcomes.

METHODS

Among 5517 patients undergoing spine surgery at a single academic institution from 2013 to 2017 and who were sent an HCAHPS survey, 27% (1480) returned the survey and answered the question related to overall hospital experience. A retrospective, comparative analysis was performed comparing patients who rated their overall hospital experience as "top-box" with those who did not. Patient demographics, comorbidities, surgical variables, and perioperative outcomes were compared between the groups. A multivariate logistic regression analysis was performed to determine patient demographics, comorbidities, and surgical variables associated with a top-box hospital rating. Additional multivariate logistic regression analyses controlling for these variables were performed to determine the association of any adverse event, major adverse events (such as myocardial infarction, pulmonary embolism), and minor adverse events (such as urinary tract infection, pneumonia); reoperation; readmission; and prolonged hospitalization with a top-box hospital rating.

RESULTS

After controlling for potential confounding variables (including patient demographics), comorbidities that differed in incidence between patients who rated the hospital top-box and those who did not, and variables related to surgery, the patient factors associated with a top-box hospital rating were older age (compared with age ≤ 40 years; odds ratio 2.2, [95% confidence interval 1.4 to 3.4]; p = 0.001 for 41 to 60 years; OR 2.5 [95% CI 1.6 to 3.9]; p < 0.001 for 61 to 80 years; OR 2.1 [95% CI 1.1 to 4.1]; p = 0.036 for > 80 years), and being a man (OR 1.3 [95% CI 1.0 to 1.7]; p = 0.028). Further, a non-top-box hospital rating was associated with American Society of Anesthesiologists Class II (OR 0.5 [95% CI 0.3 to 0.9]; p = 0.024), Class III (OR 0.5 [95% CI 0.3 to 0.9]; p = 0.020), or Class IV (OR 0.2 [95% CI 0.1 to 0.5]; p = 0.003). The only surgical factor positively associated with a top-box hospital rating was cervical surgery (compared with lumbar surgery; OR 1.4 [95% CI 1.1 to 1.9]; p = 0.016), while nonelective surgery (OR 0.5 [95% CI 0.3 to 0.8]; p = 0.004) was associated with a non-top-box hospital rating. Controlling for the same set of variables, a non-top-box rating was associated with the occurrence of any adverse event (OR 0.5 [95% CI 0.3 to 0.7]; p < 0.001), readmission (OR 0.5 [95% CI 0.3 to 0.9]; p = 0.023), and prolonged hospital stay (OR, 0.6 [95% CI 0.4 to 0.8]; p = 0.004).

CONCLUSIONS

Identifying patient factors present before surgery that are independently associated with HCAHPS scores underscores the survey's limited utility in accurately measuring the quality of care delivered to patients undergoing spine surgery. HCAHPS responses in the spine surgery population should be interpreted with caution and should consider the factors identified here. Given differing findings in the literature regarding the effect of adverse events on HCAHPS scores, future work should aim to further characterize this relationship.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Does Care Transition Matter? Exploring the Newly Published HCAHPS Measure

In recent years, health care systems have undergone a consumer revolution—putting patients at the center. The study aim was to explore the association between care transition—the new measure proposed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)—and hospital patients’ overall rating based on their experience, along with hospitals’ internal characteristics and operational attributes. Using HCAHPS and American Hospital Association published databases, the authors examined the association between hospital characteristics and measures of patient experience, focusing on the care transition measure, in 2350 US hospitals. Positive significant association was found between care transition and overall rating ( P < .0001). An interaction regression model revealed that each of the following moderators—teaching affiliation, location, and membership in a health system—significantly (all P < .05) strengthens the association between care transition and overall rating in a positive direction. These findings may help improve hospital rating, value-based payments, and patient-centered outcomes.

Challenging a Fundamental Proposition of Patient-Centeredness

This investigation challenged the proposition that physician patient-centeredness influences patients' experience-of-care (PEC). A theory-driven, three-factor, multigroup structural equation modeling design, using asymptotic-distribution-free and bootstrap estimation, with two national random and 5,000 bootstrap samples challenged the proposition's plausibility, measurement invariance, replicability, robustness against a competing model, and coherence with theory. The model fit [χ²(39) = 28, p =.900, RMSEA = .001, p = 1.00, CFI = 1.00], explaining 81 percent of PEC's variance; the proposition was invariant across samples, held against the competing model [χ²Δ(7) = 7.82, p = .97]; cross-validated against estimates from the 5,000 bootstrap samples; and agreed with theory. One standardized increase in patient-centeredness increased PEC, likelihood of recommending, and care ratings by .807, .765, and .771. Results converged in sustaining the plausibility of the proposition.

The impact of spine disease, relative to cranial disease, on perception of health and care experience: an analysis of 1484 patients in a tertiary center

OBJECTIVEPatient-reported outcomes have been increasingly mandated by regulators and payers to evaluate hospital and physician performance. The purpose of this study is to delineate the differences in patient-reported experience of hospital care for cranial and spinal operations.METHODSThe authors selected all patients who underwent inpatient, elective cranial or spinal procedures and completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey at a single, high-volume, tertiary care institution between October 2012 and September 2015. The association of the surgical procedure and diagnosis with various HCAHPS composite measures, calculated across 9 domains using standard top-box methodology, was investigated. Multivariable logistic regression models were fitted for outcomes that were significant with procedure type and diagnosis group on univariate analysis, adjusting for age, sex, case complexity, overall health rating, and education level.RESULTSA total of 1484 patients met criteria and returned an HCAHPS survey. Overall, patients undergoing a cranial procedure gave top-box (most favorable) scores more often in pain management measure (66.3% vs 59.6%, p = 0.01) compared with those undergoing spine surgery. Furthermore, despite better discharge scores (93.1% vs 87.1%, p < 0.001), spinal patients were less likely to report excellent health (7.4% vs 12.7%). Lastly, patients with a primary diagnosis of brain or spinal tumor compared with those with degenerative spinal disease and those with other neurosurgical diagnoses provided top-box scores more often regarding communication with doctors (82.7% vs 76.4% vs 75.2%, p = 0.04), pain management (71.8% vs 60.9% vs 59.1%, p = 0.002), and global rating (90.4% vs 84.0% vs 87.3%, p = 0.02). On multivariable analysis, spinal patients had significantly lower odds of reporting top-box scores in pain management (OR 0.67, 95% CI 0.52-0.85; p = 0.001), staff responsiveness (OR 0.68, 95% CI 0.53-0.87; p = 0.002), and global rating (OR 0.59, 95% CI 0.42-0.82; p = 0.002), and significantly higher odds of top-box scoring in discharge information (OR 2.15, 95% CI 1.45-3.18; p < 0.001) than cranial patients. Similarly, brain tumor cases were associated with significantly higher odds of top-box scoring in communication with doctors (OR 1.46, 95% CI 1.01-2.12; p = 0.04), pain management (OR 1.81, 95% CI 1.29-2.55; p < 0.001), staff responsiveness (OR 1.88, 95% CI 1.33-2.66; p < 0.001), and global rating (OR 2.00, 95% CI 1.26-3.17; p = 0.003) compared with degenerative spine cases.CONCLUSIONSSignificant differences in patient-reported experience with hospital care exist across different cranial and spine surgery patient populations. Overall, spinal patients, particularly those with degenerative spine disease, rated their health and their hospital experience lower relative to cranial patients. Identifying weaker areas of hospital performance in target populations can stimulate quality initiatives that aim to increase the overall hospital score.

Patient Satisfaction After Lung Cancer Surgery: Do Clinical Outcomes Affect Hospital Consumer Assessment of Health Care Providers and Systems Scores?

BACKGROUND

Little is known about patients' hospital experience and satisfaction after lung cancer surgery. We sought to determine how length of hospital stay (LOS) and postoperative complications affect hospital consumer assessment of health care providers and systems (HCAHPS) scores.

METHODS

Patients undergoing lung resection for cancer at a single academic cancer center between years 2014 and 2018 were analyzed. Clinical data were derived from The Society of Thoracic Surgeons institutional database and supplemented with HCAHPS survey data. Endpoints were "top-box" satisfaction scores and domain-specific scores for physicians and nurses communication.

RESULTS

In total, 181 of 478 patients (38%) who underwent pulmonary resection for lung cancer completed HCAHPS surveys. Median age was 65 years, and most patients underwent lobectomy (94%). The top-box rating for the overall hospital experience, physician communication, and nurse communication were 92%, 84%, and 69%, respectively. Overall and major complication rates were 43% and 3%, and were not associated with top-box HCAHPS scores. Increasing length of stay was associated with worse satisfaction with provider communication. Adjusted for patient factors, increasing length of stay was associated with worse patient satisfaction in the domains of communication with physicians and nurses. Patients with length of stay more than 6 days were less likely to endorse that doctors gave understandable explanations (odds ratio 0.15, 95% confidence interval, 0.04 to 0.56) and that nurses listened carefully (odds ratio 0.11, 95% confidence interval, 0.06 to 0.69).

CONCLUSIONS

Overall HCAHPS satisfaction scores after lung resection for cancer were high and were negatively associated with increasing length of stay. Patient satisfaction may be affected more by the perception of effective communication during prolonged hospitalizations than by complications.

A Brief Communication Curriculum Improves Resident and Nurse Communication Skills and Patient Satisfaction

BACKGROUND

Despite the ever-expanding role that the patient experience plays in healthcare, effective strategies proven to increase patient satisfaction ratings remain scarce. At the University of Pittsburgh Medical Center, we identified patient-doctor and patient-nurse communication as an area for intervention to improve suboptimal patient satisfaction among medicine inpatients. We posited that the likely reasons for underperformance in this area were a lack of adequate training in bedside communication skills.

DESIGN

We developed and evaluated a curriculum for medicine residents and nurses focused on clear communication at the bedside. A total of 76 internal medicine residents and 85 medical service nurses participated in 2016. The curriculum utilized didactics, video demonstrations, and role play, and was evaluated using pre- and post-surveys of participants' health literacy knowledge, attitudes, and confidence. Communication skills were evaluated using pre- and post-direct observation at the bedside with a communication skills checklist. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were compared 3 months before and after the curriculum to assess changes in patient satisfaction.

KEY RESULTS

Knowledge and attitudes improved significantly for both residents and nurses. Residents' and nurses' observed clinical communication skills improved significantly in most domains, and there was moderate increase in communication-specific HCAHPS scores.

CONCLUSION

A small investment of curricular time devoted to clear communication skills improved residents' and medical nurses' knowledge, attitudes, skills, and communication-specific HCAHPS scores. This curriculum, focused on improving bedside communication skills, could be implemented in a variety of settings to improve patient satisfaction and patient experience.

Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana

BACKGROUND

The Volta River Authority Hospital (VRAH) is a district hospital associated with a large public works project in Akosombo, Ghana, that has developed a reputation for high-quality care. We hypothesized that this stems from a culture of safety and standardized processes typical of high-risk engineering environments. To investigate this, we evaluated staff and patient perceptions of safety and quality, as well as perioperative process variability.

MATERIALS AND METHODS

The Safety Attitudes Questionnaire (SAQ) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to evaluate staff and patient perceptions of safety. Perioperative general surgery and obstetrical procedure observations generated process maps, which were analyzed for variability and waste.

RESULTS

Thirty-one SAQs were administered. 83% of workers held a positive perception of teamwork, and 77.4% held a positive perception of safety culture. Fifteen HCAHPS surveys of surgical inpatients showed a median hospital rating of 10 [IQR 8.5-10] on a ten-point scale. 90% gave maximal scores for pain management and 84.4% for nurse communication. Ten general surgery and obstetrical procedures were observed for which process map analysis was notable for no consistent waste steps and 100% adherence to the World Health Organization Safe Surgery Checklist.

CONCLUSIONS

Surveys suggest an institutional commitment to safety with strong teamwork culture and patient communication. Perioperative process mapping supports this culture, with low levels of variability and waste, and is useful for evaluating standardization of care. VRAH demonstrates the feasibility of delivering high standards of perioperative care in a low-resource setting.

Patient-reported experience after outpatient breast surgery

BACKGROUND

Given the growing emphasis on patient-centered care, we determined contributory factors to a positive experience among patients undergoing outpatient breast procedures.

METHODS

We retrospectively identified patients ≥18 years-old who underwent a breast operation 7/2015-12/2016 and completed a survey within two weeks. Univariate analyses evaluated associations of factors with top survey composite measures. Key driver analysis identified top-priority survey factors for improving the overall assessment measure.

RESULTS

Of 270 patients, patients who gave a top surgeon score were older (mean 62.5 vs 58.6 years, p = 0.048), more likely to report a pain score of 0 before discharge (87% vs 68%, p < 0.01), and were 30.8 times more likely to give a top rating overall (p < 0.01) than those who gave a lower surgeon score. Key driver analysis identified personal issues as the main target for improvement.

CONCLUSION

To achieve top outpatient ratings, providers should focus on personal issues, including pain control, especially in younger patients. Surgeons should consider focusing on involving the patient in treatment decisions and emphasizing pain control and overall needs to improve the patient experience.

Patient Experience After Cardiac Surgery: Identifying Areas for Improvement

BACKGROUND

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patient experience with in-hospital care. We reviewed institutional HCAHPS survey data to assess our patients' experiences after cardiac surgery and to identify targets for practice improvement.

METHODS

We reviewed data from patients undergoing the most common cardiac operations, with dismissal from October 1, 2012 to September 30, 2015. We used top-box methodology to combine survey results into nine domains, including the global (composite) hospital rating, dichotomized as high versus low. Multivariable logistic regression analysis was used to evaluate the independent associations of variables with low global ratings. Key driver analysis using domain means and Spearman correlation between the global rating and the eight other domains identified targets for quality improvement.

RESULTS

Among 1,315 surveyed patients a low global hospital rating was independently associated with low perceived overall health (fair or poor vs excellent; odds ratio [OR], 5.4; p = 0.001), younger age (18 to 59 vs ≥70 years; OR, 1.6; p = 0.048), prolonged length of stay (OR, 1.6; p = 0.02), and robotic mitral valve (MV) repair (robotic vs open repair; OR, 2.4; p = 0.045). Patients undergoing transcatheter aortic valve replacement (TAVR) reported global ratings similar to that of patients with open aortic valve operations (OR, 0.9; p = 0.64). Key drivers of patient experience were care transitions and communication regarding medications.

CONCLUSIONS

The primary targets of improvement for our institution are care transitions and communications regarding medications. The less-invasive procedures (robotic MV repair, TAVR) were not independently associated with higher patient-experience scores.

Web-Based Education Prior to Outpatient Orthopaedic Surgery Enhances Early Patient Satisfaction Scores: A Prospective Randomized Controlled Study

Background:

A good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care.

Purpose/Hypothesis:

The purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

All patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test.

Results:

A total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure “recovery” (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers’ compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores.

Conclusion:

Supplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.

Understanding health talk in an urban Aboriginal and Torres Strait Islander primary healthcare service: a cross-sectional study

Health literacy is an important determinant of health status. This cross-sectional study aimed to describe the prevalence of adequate health literacy among Aboriginal and Torres Strait Islander patients or their carers including parents of sick children attending an urban primary healthcare clinic in Australia, and their experiences of communication with General Practitioners (GPs). A questionnaire, including questions from the Brief Health Literacy Screen (BHLS) and questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS): Communication with Provider, was administered to 427 participants. Descriptive statistics, Pearson’s Chi-Square test and logistic regression analysis were used to describe the prevalence and risk factors associated with health literacy and any associations between the CAHPS questions and health literacy. In total, 72% of participants had adequate health literacy. An age of ≥50 years was independently associated with inadequate health literacy, and completion of secondary or post-secondary schooling was protective. Communication questions that identified areas for improvement included less use of incomprehensible medical words and more frequent use of visual aids. The study provides useful information on health literacy among Aboriginal and Torres Strait Islander patients, or their carers, and their experiences of communication with GPs. Further population-based research is required to investigate the effect of health literacy on health outcomes of Aboriginal and Torres Strait Islander patients.