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Longino ES, Desisto NG, Ortiz AS, Chowdhury NI, Patel PN, Stephan SJ, Yang SF. The Association of Mental Health Disorders with the Effectiveness of Treating Facial Synkinesis with Chemodenervation Using Botulinum Toxin A. Facial Plast Surg Aesthet Med 2024. [PMID: 39324239 DOI: 10.1089/fpsam.2024.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
Background: Studies suggest that mood disorders may affect perception of facial synkinesis, though none have analyzed effects on perceived benefit from chemodenervation. Objective: To measure the effect of depression, appearance anxiety, and other variables on chemodenervation benefit among patients with post-paralytic facial synkinesis. Design Type: Prospective cohort. Methods: Patients volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), Facial Clinimetric Evaluation Scale (FaCE), Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Multivariate regression was used to analyze the effect of CES-D, FNAES, and demographics on pre- and post-chemodenervation SAQ and FaCE. Results: In total, 100 patients participated, 90% were female. Mean age was 56.4 (SD 12.3) years. The most common paralysis etiology was idiopathic (47%). Average synkinesis duration was 7.6 (6.2) years and treatment duration 4.9 (4.8) years. Older age and prior treatment (p < 0.05) were associated with reduced SAQ improvement; worse CES-D approached significance (p = 0.09). Reported history of anxiety was associated with greater SAQ improvement (p = 0.05). Factors associated with reduced FaCE improvement included higher baseline CES-D and prior treatment (p < 0.05). Conclusions: Older age, worse depression scores, and prior treatments may be associated with reduced patient-graded improvement following chemodenervation. History of anxiety may be associated with greater improvement.
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Affiliation(s)
- Elizabeth S Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicole G Desisto
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexandra S Ortiz
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Priyesh N Patel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott J Stephan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Longino ES, Desisto NG, Ortiz AS, Chowdhury NI, Patel PN, Stephan SJ, Yang SF. Effect of Underlying Mental Health Disorders on the Correlation Between Patient- and Surgeon-Graded Synkinesis Scores. Facial Plast Surg Aesthet Med 2024; 26:544-550. [PMID: 38569157 DOI: 10.1089/fpsam.2023.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: Little is known about how depression and appearance anxiety affect patient reporting of synkinesis severity. Learning/Study Objective: Measure prevalence of depression and appearance anxiety in facial synkinesis and correlations between subjective and surgeon-graded synkinesis severity. Design Type: Prospective cohort. Methods: Patients with synkinesis volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), facial clinimetric evaluation (FaCE) scale, Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Standardized videos were scored by facial plastic surgeons using Sunnybrook Scale and eFaCE. Multivariate linear regression was used to compare patient- and surgeon-graded metrics. Results: One hundred patients participated, 91 were female. Mean age was 56.4 (12.3). Eight percent identified as Black and 87% White. The most common nerve injury etiology was idiopathic (47%). Mean synkinesis duration was 7.6 years (6.2). Twenty percent and 15% reported history of an anxiety or depressive disorder, respectively. Patient (SAQ, FaCE) and clinician (Sunnybrook, eFaCE) scores were correlated (Pearson's r 0.223-0.294, p < 0.05). Upon adjusting for CES-D/FNAES, correlations between most patient and clinician metrics became stronger. As CES-D and FNAES worsened, patient-clinician correlations weakened. Conclusions: Depression and appearance anxiety may affect patient reporting of synkinesis severity. Worse mental health scores may decorrelate patient and clinician synkinesis assessments.
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Affiliation(s)
- Elizabeth S Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nichole G Desisto
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexandra S Ortiz
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Priyesh N Patel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott J Stephan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Park S, Meyers DJ, Jimenez DE, Gualdrón N, Cook BL. Health Care Spending, Use, and Financial Hardship Among Traditional Medicare and Medicare Advantage Enrollees With Mental Health Symptoms. Am J Geriatr Psychiatry 2024; 32:739-750. [PMID: 38267358 DOI: 10.1016/j.jagp.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We examined the differences in health care spending and utilization, and financial hardship between Traditional Medicare (TM) and Medicare Advantage (MA) enrollees with mental health symptoms. DESIGN Cross-sectional study. PARTICIPANTS We identified Medicare beneficiaries with mental health symptoms using the Patient Health Questionnaire-2 and the Kessler-6 Psychological Distress Scale in the 2015-2021 Medical Expenditure Panel Survey. MEASUREMENTS Outcomes included health care spending and utilization (both general and mental health services), and financial hardship. The primary independent variable was MA enrollment. RESULTS MA enrollees with mental health symptoms were 2.3 percentage points (95% CI: -3.4, -1.2; relative difference: 16.1%) less likely to have specialty mental health visits than TM enrollees with mental health symptoms. There were no significant differences in total health care spending, but annual out-of-pocket spending was $292 (95% CI: 152-432; 18.2%) higher among MA enrollees with mental health symptoms than TM enrollees with mental health symptoms. Additionally, MA enrollees with mental health symptoms were 5.0 (95% CI: 2.9-7.2; 22.3%) and 2.5 percentage points (95% CI: 0.8-4.2; 20.9%) more likely to have difficulty paying medical bills over time and to experience high financial burden than TM enrollees with mental health symptoms. CONCLUSION Our findings suggest that MA enrollees with mental health symptoms were more likely to experience limited access to mental health services and high financial hardship compared to TM enrollees with mental health symptoms. There is a need to develop policies aimed at improving access to mental health services while reducing financial burden for MA enrollees.
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Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management (SP), College of Health Science, Korea University, Seoul, Republic of Korea; BK21 FOUR R&E Center for Learning Health Systems (SP), Korea University, Seoul, Republic of Korea.
| | - David J Meyers
- Department of Health Services, Policy, and Practice (DJM), School of Public Health, Brown University, Providence, RI, USA
| | - Daniel Enrique Jimenez
- Department of Psychiatry and Behavioral Sciences (DEJ), Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Nattalie Gualdrón
- Health Equity Research Lab (NG, BLC), Cambridge Health Alliance, Cambridge, MA, USA; Department of Community Health (NG), School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Benjamin Le Cook
- Health Equity Research Lab (NG, BLC), Cambridge Health Alliance, Cambridge, MA, USA; Center for Health Equity (BLC), Albert Einstein College of Medicine, Bronx, NY, USA; Department of Psychiatry (BLC), Harvard Medical School, Cambridge, MA, USA
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4
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Arevalo M, Pickering TA, Vernon SW, Fujimoto K, Peskin MF, Farias AJ. Do breast cancer survivors with a recent history of clinical depression report worse experiences with care? A retrospective cohort study using SEER-CAHPS data. Cancer Med 2022; 12:1949-1960. [PMID: 35929584 PMCID: PMC9883547 DOI: 10.1002/cam4.5031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity. METHODS Using the Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, getting care quickly, getting prescription drugs, specialist and overall care). We also assessed interactions of depression by race/ethnicity. All models were adjusted for demographics and cancer prognostic and treatment factors. RESULTS Of the 2271 survivors, 7.6% were clinically depressed. After adjusting for covariates, survivors with clinical depression had lower odds of reporting excellent ratings of their ability to get needed care, care by their specialist, and overall care, compared to those without depression (AOR = 0.58, 95% CI: 0.40-0.84; AOR = 0.40, CI: 0.31-0.76; and AOR = 0.61, CI: 0.42-0.89, respectively). Among Hispanics, having depression was associated with higher odds of excellent ratings of one's ability to get needed care (AOR: 5.42, 95% CI: 1.02-28.81). No other statistically significant associations by race/ethnicity were found. CONCLUSIONS Breast cancer survivors with depression report poorer patient experiences with care. Further research is needed to understand complexities of ratings of experiences with care among survivors of diverse backgrounds. IMPLICATIONS Survivors with a recent history of clinical depression may benefit from additional supportive care services.
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Affiliation(s)
- Mariana Arevalo
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Trevor A. Pickering
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sally W. Vernon
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Melissa F. Peskin
- Department of Health Promotion & Behavioral SciencesSchool of Public Health, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Albert J. Farias
- Department of Preventive MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA,Gehr Family Center for Health System ScienceKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA,Cancer Control Research ProgramUniversity of Southern California Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
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5
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Predictors of Employment Status for Persons with Bipolar Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063512. [PMID: 35329198 PMCID: PMC8950595 DOI: 10.3390/ijerph19063512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 12/04/2022]
Abstract
Bipolar disorder is characterized by manic and depressive episodes and can be a lifetime condition. Bipolar disorder has been found to be associated with various types of disabilities, including low employment rate and high dependence on public aid. The purpose of this study is to identify factors related to being employed for persons with bipolar disorder. Nine thousand eight hundred and eighty-six subjects with bipolar disorder were collected between July of 2012 and November of 2013 and retrieved from Taiwan national disability database on May of 2014. The mean age of the sample is 45.41 (SD = 10.5), with 64% as female. Logistic regression was used to examine the log odds of the predictive variables on outcome of employment. A Receiver Operating Characteristics analysis was applied to locate the cutoff score of World Health Organization Disability Assessment Schedule 2.0 for being employed. All demographic variables were found to be significantly correlated with employment status among subjects. The Receiver Operating Characteristics results revealed that those subjects whose scores were below 33.57 had about a four-fold higher probability of being in employment than those whose scores were above 33.57. The result provides insights into future research effort and intervention design aimed at helping persons with bipolar disorder to obtain gainful employment.
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6
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Indovina KA, Keniston A, Manchala V, Burden M. Predictors of a Top-Box Patient Experience: A Retrospective Observational Study of HCAHPS Data at a Safety Net Institution. J Patient Exp 2021; 8:23743735211034342. [PMID: 34377774 PMCID: PMC8320559 DOI: 10.1177/23743735211034342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Hospitals commonly seek to improve patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, yet there are limited data to guide improvement efforts. The HCAHPS survey was developed for interhospital comparisons, whereas its use in intrahospital comparisons has not been validated. We sought to better understand the validity of utilizing intrahospital score comparisons and to identify the factors that may predict top-box HCAHPS scores. We performed a retrospective observational cohort study at an academic urban safety-net hospital examining 4898 HCAHPS surveys completed by hospitalized patients. We found that while most Patient-Mix Adjustment factors for which HCAHPS scores are adjusted were associated with top-box scores on intrahospital comparisons, few additional variables were associated with top-box scores. Further, HCAHPS questions pertaining to nurse and doctor communication were highly correlated with overall hospital rating, suggesting that communication-related factors may influence a patient’s hospital experience more strongly than do administrative factors.
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Affiliation(s)
- Kimberly A Indovina
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Venkata Manchala
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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7
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Nho JH, Park SK. Factors affecting unmet healthcare needs of low-income overweight and obese women in Korea: analysis of the Korean National Health and Nutrition Examination Survey 2017. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2021; 27:93-103. [PMID: 36313135 PMCID: PMC9334183 DOI: 10.4069/kjwhn.2021.05.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/08/2001] [Accepted: 05/06/2021] [Indexed: 07/29/2023] Open
Abstract
Purpose The purpose of this study was to explore unmet healthcare needs among low-income overweight and obese women and to identify the factors affecting unmet healthcare needs. Methods The study was a secondary analysis of data from the 2017 Korea National Health and Nutrition Examination Survey. A final sample of 388 out of 8,127 participants was analyzed using complex descriptive statistics, the chi-square test, the independent t-test, and logistic regression. Results The mean age of the participants was 66.51±1.05 years. Unmet healthcare needs were experienced by 19.4% of low-income overweight and obese women. Women with depression, stress, and poor self-reported health status were significantly more likely than their counterparts to experience unmet healthcare needs. Poor self-reported health status was confirmed to be related to unmet health needs in low-income overweight and obese women (odds ratio, 2.65; p=.011). Conclusion The study provides the novel insight that the unmet healthcare needs of low-income overweight and obese women were influenced by self-reported health status. Healthcare providers should make efforts to develop strategies to reduce unmet healthcare needs among low-income overweight and obese women, who constitute a vulnerable population.
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Affiliation(s)
- Ju-Hee Nho
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
| | - Sook Kyoung Park
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea
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8
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Katz IR, Resnick S, Hoff R. Associations between patient experience and clinical outcomes in general mental health clinics: Findings from the veterans outcomes assessment survey. Psychiatry Res 2021; 295:113554. [PMID: 33183768 DOI: 10.1016/j.psychres.2020.113554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/31/2020] [Indexed: 01/27/2023]
Abstract
For mental health, evidence linking the patients' experiences of care with treatment outcomes is limited. We report findings from the Veterans Outcome Assessment (VOA) survey of Veterans beginning treatment in Veterans Health Administration (VHA) mental health programs with follow-up after approximately 3 months. In addition to assessments of symptoms and functioning, it includes key components of the Experience of Care and Health Outcomes (ECHO) survey including patient reports of communication with clinicians and of the overall quality of mental health care. For Veterans treated in VHA general mental health clinics, significant associations between ratings of communication and quality at baseline, and both retention in treatment and patient-reported outcomes assessed at follow-up demonstrate that better patient experience predicts more favorable outcomes. Further research is necessary to determine whether including them in measurement-based care could improve outcomes by facilitating the early identification of problems in providing care.
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Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC; Philadelphia VA Medical Center, Philadelphia, PA.
| | - Sandra Resnick
- Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Rani Hoff
- Northeast Program Evaluation Center, VA Office of Mental Health and Suicide Prevention, West Haven VA Medical Center, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT
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9
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Lum M, Garnett M, Sheridan J, O'Connor E, Meuter R. Healthcare communication distress scale: Pilot factor analysis and validity. PATIENT EDUCATION AND COUNSELING 2020; 103:1302-1310. [PMID: 32067857 DOI: 10.1016/j.pec.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To develop psychometrically an evidence-based, patient-centred measure of patient-practitioner communication. We explored the underlying constructs of a self-report questionnaire measuring adult patients' enduring perceptions of their emotional experiences when communicating with primary healthcare practitioners. METHODS A cross-sectional on-line survey included 16 items from a piloted questionnaire, as well as existing measures of generalised anxiety, psychological distress, and body vigilance. Exploratory factor analysis and hierarchical multiple regression were used to explore underlying constructs in an Australian sample (N = 220). RESULTS A 6-item communication distress factor and a 3-item environmental arousal factor were supported, indicating good face validity and internal consistency. Bivariate correlations support convergent and discriminant validity for both factors. Hierarchical analysis exploring predictors of communication distress included sex, age, and chronic condition status; and scores on body vigilance, anxiety, distress, and environmental arousal in healthcare. Environmental arousal was the most important significant predictor of communication distress. CONCLUSION The patient communication questionnaire can be developed into a brief scale to measure patient distress associated with engaging with, and communicating in, healthcare settings. PRACTICE IMPLICATIONS A brief self-report measure to identify patients' communication distress and environmental arousal could assist in clinical practice and provide useful data in healthcare communication research.
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Affiliation(s)
- Michelle Lum
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.
| | - Michelle Garnett
- Minds & Hearts Clinic, 6/88 Boundary Street, West End, QLD, 4101, Australia.
| | - Judith Sheridan
- Kenmore Psychology, 7/18 Brookfield Road, Kenmore, QLD, 4069, Australia.
| | - Erin O'Connor
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.
| | - Renata Meuter
- School of Psychology and Counselling, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.
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10
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Shields MC, Singer J, Rosenthal M, Sato L, Keohane C, Janes M, Boulanger J, Martins N, Rabson B. Patient Engagement Activities and Patient Experience: Are Patients With a History of Depression the Canary in the Coal Mine? Med Care Res Rev 2019; 78:251-259. [PMID: 31117918 DOI: 10.1177/1077558719850705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about the effectiveness of primary care practices' efforts to engage patients in their health and health care. We examine the association between patient engagement efforts and patients' experiences of care. We found no association between an unweighted count of patient engagement activities and patient experience. Compared with the bottom quartile of practices, however, the top quartile had better performance on patient experience domains of communication, front-office staff, and organizational access (out of nine domains). Furthermore, patients reporting a diagnosis of depression have higher ratings across five domains of patient experience when in practices with higher levels of patient engagement activities measured using an unweighted scale. Future research is needed to understand how the benefits of patient engagement activities can accrue to more patient subgroups. These promising results suggest that payers and policy makers should continue to support implementation and benchmarking of patient engagement efforts across practices.
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Affiliation(s)
| | - Janice Singer
- The Massachusetts Health Quality Partners, Watertown, MA, USA
| | | | - Luke Sato
- Risk Management Foundation of the Harvard Medical Institutions Incorporated (CRICO/RMF), Boston, MA, USA
| | - Carol Keohane
- Risk Management Foundation of the Harvard Medical Institutions Incorporated (CRICO/RMF), Boston, MA, USA
| | - Margaret Janes
- Risk Management Foundation of the Harvard Medical Institutions Incorporated (CRICO/RMF), Boston, MA, USA
| | - Jason Boulanger
- Risk Management Foundation of the Harvard Medical Institutions Incorporated (CRICO/RMF), Boston, MA, USA
| | - Natalya Martins
- The Massachusetts Health Quality Partners, Watertown, MA, USA
| | - Barbra Rabson
- The Massachusetts Health Quality Partners, Watertown, MA, USA
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11
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Nelson KL, Purtle J. Perceptions of patient-provider communication and receipt of mental health treatment among older adults with depressive symptoms. Aging Ment Health 2019; 23:485-490. [PMID: 29338318 DOI: 10.1080/13607863.2018.1426719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to: (1) determine if and how perceptions towards healthcare providers differ between older adults with and without clinically signifcant depressive symptoms (CSDS), and (2) assess whether perceptions towards providers are associated with receipt of mental health treatment among older adults with CSDS. METHODS Data from the 2013 and 2014 Medical Expenditure Panel Survey were used to examine CSDS prevalence, receipt of mental health treatment, and perceptions of provider communication among community-dwelling adults ≥ age 65 (N = 6,936) using four of the 'How Well Doctors Communicate' composite items from the Consumer Assessment of Healthcare Providers and Systems(CAHPS). Multivariate logistic regression was used. RESULTS CSDS are associated with greater odds of having 'poor' perceptions of provider communication on all four CAHPS communication measures. Perceptions of provider communication are similar among older adults with CSDS who received and did not receive mental health treatment, except on an item measuring a provider's ability to explain information in ways patients understand. CONCLUSION Older adults with CSDS have more negative perceptions of the quality of their communication with healthcare providers than their peers. Healthcare systems should consider how to accommodate these patients' unique needs and communication preferences to ensure receipt of quality care.
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Affiliation(s)
- Katherine L Nelson
- a Department of Health Management and Policy, Dornsife School of Public Health , Drexel University , Philadelphia , PA , USA
| | - Jonathan Purtle
- a Department of Health Management and Policy, Dornsife School of Public Health , Drexel University , Philadelphia , PA , USA
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12
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Clignet F, Houtjes W, van Straten A, Cuijpers P, van Meijel B. Unmet care needs, care provision and patient satisfaction in patients with a late life depression: a cross-sectional study. Aging Ment Health 2019; 23:491-497. [PMID: 29356572 DOI: 10.1080/13607863.2018.1426716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research has shown that some 30% of total care needs in people with late-life depression (LLD) are unmet. It is not known to what extent patients actually don't receive any care for these needs or consider the care to be insufficient and their satisfaction with the provided care. AIM The aim of this study is to obtain insight into the care provided in relation to the reported unmet care needs and satisfaction with the total care provided is examined. METHOD A cross-sectional study of 99 people with LLD in an ambulatory setting. RESULTS In 67% of patients, at least one unmet need was ascertained. In most cases (80%) care was actually provided for those needs by professionals and/or informal caregivers. Patients were satisfied with the care delivered for 81% of the reported care needs. Satisfaction was lowest for social care needs (67%). For six specific care needs it was demonstrated that dissatisfied patients were significantly more depressed than satisfied patients. CONCLUSION Even though patients might receive care for certain needs, this does not mean that their needs are met. A substantial proportion of patients with LDD feel that they need additional help for unmet needs.
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Affiliation(s)
- Frans Clignet
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands.,b Department of old age psychiatry , Altrecht specialists in Mental Health Care , Zeist , 3705 WH , Netherlands
| | - Wim Houtjes
- c GGZ-VS, Academy for Clinical Nurse Specialists in mental healthcare , Utrecht , 3511 GE , Netherlands
| | - Annemieke van Straten
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands
| | - Pim Cuijpers
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands
| | - Berno van Meijel
- d Department of Health & Self-management , Inholland University of Applied Sciences , Amsterdam , 1081 HV , Netherlands
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13
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Finch BK, Haas A, Haviland AM, Dembosky JW, Gaillot S, Elliott MN. Educational Attainment and Perceived Need for Urgent Care. Med Care Res Rev 2018; 77:428-441. [PMID: 30296886 DOI: 10.1177/1077558718804748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While lower educational attainment is associated with worse health status, education may also affect one's ability to identify need for urgent care. Using data from the 2010 Medicare CAHPS survey, we estimated multivariate logistic models to test the relationship between self-reported educational attainment and the perceived need for urgent care, controlling for health status and other factors. As expected, lower educational attainment was associated with greater reported need for urgent care in bivariate analyses because of poorer health. However, lower educational attainment was associated with less perceived need for urgent care after controlling for health status, particularly for those in poor health. These findings suggest the need for interventions to improve the likelihood that people with less education recognize the need for urgent care, particularly those in poor health and in most need of urgent care.
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Affiliation(s)
- Brian K Finch
- University of Southern California, Los Angeles, CA, USA
| | - Ann Haas
- RAND Corporation, Pittsburgh, PA, USA
| | - Amelia M Haviland
- RAND Corporation, Pittsburgh, PA, USA.,Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
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14
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Brunner J, Schweizer CA, Canelo IA, Leung LB, Strauss JL, Yano EM. Timely access to mental health care among women veterans. Psychol Serv 2018; 16:498-503. [PMID: 29620391 DOI: 10.1037/ser0000226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Using survey data on (N = 419) patients at Department of Veterans Affairs (VA) clinics we analyzed women veterans' reports of timely access to VA mental health care. We evaluated problems that patients might face in obtaining care, and examined subjective ratings of VA care as a function of timely access to mental health care. We found that 59% of participants reported "always" getting an appointment for mental health care as soon as needed. In adjusted analyses, two problems were negatively associated with timely access to mental health care: (a) medical appointments that interfere with other activities, and (b) difficulty getting questions answered between visits. Average subjective ratings of VA ranged from 8.2-8.6 out of 10, and 93% of participants would recommend VA care. Subjective ratings of VA were higher among women who reported timely access to mental health care. Findings suggest that overall experience of care is associated with timely access to mental health care, and that such access may be amenable to improvements related to clinic hours or mechanisms for answering patient questions between visits. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Julian Brunner
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System
| | - C Amanda Schweizer
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System
| | - Ismelda A Canelo
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System
| | - Lucinda B Leung
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System
| | - Jennifer L Strauss
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs
| | - Elizabeth M Yano
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System
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15
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Hatfield LA, Zaslavsky AM. Implications of Variation in the Relationships between Beneficiary Characteristics and Medicare Advantage CAHPS Measures. Health Serv Res 2016; 52:1310-1329. [PMID: 27500888 DOI: 10.1111/1475-6773.12544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To study how differences in quality score adjustments across Medicare Advantage contracts change comparisons for individuals and contracts. DATA SOURCES Responses to the Medicare Advantage implementation of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey from 2010 to 2014. STUDY DESIGN We fit national-and state-level hierarchical models to predict CAHPS scores for individuals and contracts, adjusted for self-reported education, general health, and mental health. We allow the effects of these variables on quality measures to vary across contracts with a hierarchical model. DATA COLLECTION/EXTRACTION METHODS We perform secondary data analysis. PRINCIPAL FINDINGS For average consumers, standard adjustment is sufficient to represent variation in contract quality standardized to a common population. For people with characteristics far from average, personalized reporting using their characteristics and contract-specific coefficients can substantially change the expected quality measures across contracts. This effect is stronger when comparing among contracts within a state than across all contracts. CONCLUSIONS Customized reporting may help consumers select the best Medicare Advantage plan, but policies should protect against unintended consequences.
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Affiliation(s)
- Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA
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16
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The Effect of a Care Transition Intervention on the Patient Experience of Older Multi-Lingual Adults in the Safety Net: Results of a Randomized Controlled Trial. J Gen Intern Med 2015; 30:1788-94. [PMID: 25986136 PMCID: PMC4636586 DOI: 10.1007/s11606-015-3362-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Care Transitions Measure (CTM-3) scores are patient experience measures used to determine hospital value-based purchasing reimbursement. Interventions to improve 30-day readmissions have met with mixed results, but less is known about their potential to improve the patient experience among older ethnically and linguistically diverse adults receiving care at safety-net hospitals. In this study, we assessed the effect of a nurse-led hospital-based care transition intervention on discharge-related patient experience in an older multilingual population of adults hospitalized at a safety-net hospital. METHODS We randomized 700 inpatients aged 55 and older at an academic urban safety-net hospital. In addition to usual care, intervention participants received inpatient visits by a language-concordant study nurse and post-discharge phone calls from a language-concordant nurse practitioner to reinforce the care plan and to address acute complaints. We measured HCAHPS nursing, medication, and discharge communication domain scores and CTM-3 scores at 30 days after hospital discharge. RESULTS Of 685 participants who survived to 30 days, 90 % (n = 616) completed follow-up interviews. The mean age was 66.2 years; over half (54.2 %) of the participants had cognitive impairment, and 33.8 % had moderate to severe depression. The majority (62.1 %) of interviews were conducted in English; 23.3 % were conducted in Chinese and 14.6 % in Spanish. Study nurses spent an average of 157 min with intervention participants. Between intervention and usual care participants, CTM-3 scores (80.5 % vs 78.5 %; p = 0.18) and HCAHPS discharge communication domain scores (74.8 % vs 68.7 %; p = 0.11) did not differ, nor did HCAHPS scores in medication (44.5 % vs 53.1 %; p = 0.13) and nursing domains (67.9 % vs 64.9 %; p = 0.43). When stratified by language, no significant differences were seen. CONCLUSION An inpatient standalone transition-of-care intervention did not improve patient discharge experience. Older multi-lingual and cognitively impaired populations may require higher-intensity interventions post-hospitalization to improve discharge experience outcomes.
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Martino SC, Elliott MN, Haviland AM, Saliba D, Burkhart Q, Kanouse DE. Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee-for-Service. Health Serv Res 2015; 51:1002-20. [PMID: 26368572 DOI: 10.1111/1475-6773.12359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). DATA SOURCES Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. STUDY DESIGN Multivariate linear regression was used to test whether case-mix-adjusted associations between depressive symptoms and patient experience differed for beneficiaries in MA versus FFS. Dependent measures included four measures of beneficiaries' experiences with doctors (e.g., reports of doctor communication) and seven measures of beneficiaries' experiences with plans (e.g., customer service). PRINCIPAL FINDINGS Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. CONCLUSIONS Disparities in care experienced by older Medicare beneficiaries with depressive symptoms tend to be more negative in managed care than in FFS. Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment.
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Affiliation(s)
| | | | | | - Debra Saliba
- UCLA, JH Borun Center and Los Angeles Veterans Administration Health System, Los Angeles, CA
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18
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Chawla N, Urato M, Ambs A, Schussler N, Hays RD, Clauser SB, Zaslavsky AM, Walsh K, Schwartz M, Halpern M, Gaillot S, Goldstein EH, Arora NK. Unveiling SEER-CAHPS®: a new data resource for quality of care research. J Gen Intern Med 2015; 30:641-50. [PMID: 25586868 PMCID: PMC4395616 DOI: 10.1007/s11606-014-3162-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/24/2014] [Accepted: 12/02/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Since 1990, the National Cancer Institute (NCI) and Centers for Medicare and Medicaid Services (CMS) have collaborated to create linked data resources to improve our understanding of patterns of care, health care costs, and trends in utilization. However, existing data linkages have not included measures of patient experiences with care. OBJECTIVE To describe a new resource for quality of care research based on a linkage between the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient surveys and the NCI's Surveillance, Epidemiology and End Results (SEER) data. DESIGN This is an observational study of CAHPS respondents and includes both fee-for-service and Medicare Advantage beneficiaries with and without cancer. The data linkage includes: CAHPS survey data collected between 1998 and 2010 to assess patient reports on multiple aspects of their care, such as access to needed and timely care, doctor communication, as well as patients' global ratings of their personal doctor, specialists, overall health care, and their health plan; SEER registry data (1973-2007) on cancer site, stage, treatment, death information, and patient demographics; and longitudinal Medicare claims data (2002-2011) for fee-for-service beneficiaries on utilization and costs of care. PARTICIPANTS In total, 150,750 respondents were in the cancer cohort and 571,318 were in the non-cancer cohort. MAIN MEASURES The data linkage includes SEER data on cancer site, stage, treatment, death information, and patient demographics, in addition to longitudinal data from Medicare claims and information on patient experiences from CAHPS surveys. KEY RESULTS Sizable proportions of cases from common cancers (e.g., breast, colorectal, prostate) and short-term survival cancers (e.g., pancreas) by time since diagnosis enable comparisons across the cancer care trajectory by MA vs. FFS coverage. CONCLUSIONS SEER-CAHPS is a valuable resource for information about Medicare beneficiaries' experiences of care across different diagnoses and treatment modalities, and enables comparisons by type of insurance.
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Affiliation(s)
- Neetu Chawla
- Division of Cancer Control and Population Sciences, Cancer Prevention Fellow, National Cancer Institute, 9609 Medical Center Drive, 3E450, Rockville, MD, 20892, USA,
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Keller AO, Gangnon R, Witt WP. Favorable ratings of providers' communication behaviors among U.S. women with depression: a population-based study applying the behavioral model of health services use. Womens Health Issues 2013; 23:e309-17. [PMID: 23993478 DOI: 10.1016/j.whi.2013.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 06/20/2013] [Accepted: 07/10/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the relationships between sociodemographic characteristics and ratings of provider communication behavior among women with depression in the United States. This study uses the Andersen Behavioral Model to examine the relationships among predisposing, enabling, and need factors and ratings of perceived patient-provider communication in women with depression. METHODS The sample consisted of women with depression who visited any provider in the previous 12 months in the 2002-2008 Medical Expenditure Panel Survey (n = 3,179; weighted n = 4,707,255). Multivariate logistic regression was used to examine the independent contribution of predisposing, enabling, and need factors on providers' communication behavior measures. FINDINGS Black (non-Hispanic) women were more likely to report that providers always listened carefully (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.01-1.94), explained so they understood (OR, 1.53; 95% CI, 1.10-2.11), and showed respect for what they had to say (OR, 1.39; 95% CI, 1.01-1.92). Women participating in the paid workforce and those without a usual source of care were at increased risk for less favorable experiences. CONCLUSIONS Participation in the paid workforce and lack of a usual source of care were associated with an increased likelihood of less optimal communication experiences. IMPLICATIONS FOR PRACTICE AND/OR POLICY Ensuring that women with depression have reliable access to a continuous source of care and expanding the availability of nonemergent, after-hours care may be instrumental for improving patient-provider communication in this population.
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Affiliation(s)
- Abiola O Keller
- Center for Women's Health and Health Disparities Research, University of Wisconsin, Madison, WI 53705, USA.
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Risk factors for reporting poor cultural competency among patients with diabetes in safety net clinics. Med Care 2012; 50:S56-61. [PMID: 22895232 DOI: 10.1097/mlr.0b013e3182640adf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set assesses patient perceptions of aspects of the cultural competence of their health care. OBJECTIVE To determine characteristics of patients who identify the care they receive as less culturally competent. RESEARCH DESIGN Cross-sectional survey consisting of face-to-face interviews. SUBJECTS Safety-net population of patients with type 2 diabetes (n=600) receiving ongoing primary care. MEASURES Participants completed the Consumer Assessment of Healthcare Providers and Systems Cultural Competency and answered questions about their race/ethnicity, sex, age, education, health status, depressive symptoms, insurance coverage, English proficiency, duration of relationship with primary care provider, and comorbidities. RESULTS In adjusted models, depressive symptoms were significantly associated with poor cultural competency in the Doctor Communication--Positive Behaviors domain [odds ratio (OR) 1.73, 95% confidence interval, 1.11-2.69]. African Americans were less likely than whites to report poor cultural competence in the Doctor Communication--Positive Behaviors domain (OR 0.52, 95% CI, 0.28-0.97). Participants who reported a longer relationship (≥ 3 y) with their primary care provider were less likely to report poor cultural competence in the Doctor Communication--Health Promotion (OR 0.35, 95% CI, 0.21-0.60) and Trust domains (OR 0.4, 95% CI, 0.24-0.67), whereas participants with lower educational attainment were less likely to report poor cultural competence in the Trust domain (OR 0.51, 95% CI, 0.30-0.86). Overall, however, sociodemographic and clinical differences in reports of poor cultural competence were insignificant or inconsistent across the various domains of cultural competence examined. CONCLUSIONS Cultural competence interventions in safety-net settings should be implemented across populations, rather than being narrowly focused on specific sociodemographic or clinical groups.
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