Factors associated with perceived patient-provider communication quality among Puerto Ricans

Patients' perceptions of patient-centered communication with healthcare providers and associated factors in Japan - The INFORM Study 2020

OBJECTIVE

To describe patients' perceptions of the patient-centeredness of their communication with healthcare providers in Japan, and to examine factors associated with these perceptions.

METHODS

We analyzed the cross-sectional data from the INFORM Study 2020, which is a nationwide survey on health information access in Japan. A total of 3605 respondents completed the survey. Our primary outcome was the nine elements of the patient-centered communication scale (PCCS), which was compiled from 2703 respondents (75.0%) reporting at least one provider visit within 12 months. It was rated on a four-point Likert scale: always, usually, sometimes, and never. We used binary logistic regression to examine the association between sociodemographic and health-related variables, and each element of the PCCS.

RESULTS

For all elements, the percentage of respondents who agreed that their healthcare providers always communicated in a patient-centered way was low (17-31%). Patients with higher age, higher education, poorer general health status and a larger number of visits to providers in the previous 12 months were more likely to have positive perception.

CONCLUSION

Patient-centered communication as reported in a national sample in Japan was low.

CLINICAL IMPLICATIONS

Efforts are needed to improve the patient-centeredness of patient-provider communication in Japan to optimize health outcomes.

A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys

High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.

Correlates of the perceived quality of patient-provider communication among German adults

BACKGROUND

Since a higher perceived quality of patient-provider communication is known to be associated with improved health outcomes, it is essential to analyze determinants influencing patients' perceived quality of patient-provider communication. Due to the limited knowledge about patient-related influencing factors of quality perception available so far, the objective of this study is to explore and assess determinants of the perceived quality of patient-provider communication with regards to sociodemographic, health-related, healthcare-specific and information-related factors.

METHODS

Linear regression of cross-sectional data from the first wave of Health Information National Trends Survey Germany (n = 2902) was conducted. Independent variables were sociodemographic, health-, healthcare- and information-related factors; the dependent variable was the perceived quality of patient-provider communication.

RESULTS

Results show that age, migration background, the perceived quality of healthcare, health-related self-efficacy and trust in health information from health professionals are significantly associated with the perceived quality of patient-provider communication.

CONCLUSIONS

Sociodemographic, healthcare- and health information-related factors influence the perceived quality of patient-provider communication. In particular, patients having a migration background and patients reporting low self-efficacy showed significant lower levels of their perceived patient-provider communication quality. With the aim to improve quality issues, patients of both target groups should be empowered and supported.

Experience and knowledge of Lyme disease: A scoping review of patient-provider communication

There has been limited research on patient-provider communication dynamics regarding Lyme disease (LD) diagnosis and treatment. Evidence suggests communication in the clinical encounter improves when both patient and healthcare provider (HCP) have concordant orientations (or beliefs) on discussed topics, resulting in higher patient satisfaction and care outcomes. The purpose of this scoping review was to characterize and summarize current research findings on patient and provider knowledge and experiences regarding LD - two factors that may influence the orientation of both patients and providers toward LD in the clinical setting. None of the articles included in the review specifically addressed patient-provider interaction and relationships as the main objective. However, the existing literature indicates notable HCP uncertainty regarding LD diagnosis, treatment, and applied practice patterns. Current research also describes limited knowledge of LD among patient populations and a high prevalence of negative perceptions of care received in mainstream healthcare settings among individuals with persistent symptoms. We identified a critical gap in research that seeks to understand the dynamic of patients and HCPs communicating on the topic of LD in the clinical setting. Future research may identify opportunities where the patient-provider communication dynamic can be improved.

A systematic review of psychosocial interventions for Latinx and American Indian patient-family caregiver dyads coping with chronic health conditions

Latinx and American Indians experience high rates of chronic health conditions. Family members play a significant role as informal caregivers for loved ones with chronic conditions and both patients and family caregivers report poor psychosocial outcomes. This systematic review synthesizes published studies about psychosocial interventions for Latinx and American Indian care dyads to determine: (i) the benefits of these interventions; (ii) their distinguishing features or adaptations, and; (iii) recommendations for future intervention development. Out of 366 records identified, seven studies met inclusion criteria. Interventions demonstrated benefits to outcomes such as disease knowledge, caregiver self-efficacy and burden, patient and caregiver well-being, symptom distress, anxiety and depression, and dyadic communication. Distinguishing features included tailoring to cultural values, beliefs, and delivery preferences, participants' level of acculturation, and population-specific issues such as migratory stressors and support networks. Based upon this review, six recommendations for future intervention development are put forth.

Racial/Ethnic Disparities in Patient-Provider Communication and the Role of E-Health Use

Although the health care industry has strived to address racial/ethnic disparities in health communication, several gaps remain. Previous findings suggest that communication technology might help narrow the gaps; however, they do not provide a comprehensive picture of how or why. To answer these questions, we examined the potential role of communication technology in mitigating the racial/ethnic disparities in patient-provider communication. Data analysis of the 2018 Health Information National Trends Survey (N= 3,504) revealed that the levels of perceived quality of communication with health care providers were lower among Asians and Hispanics than non-Hispanic Whites while no difference emerged between Blacks and non-Hispanic Whites. Although the adoption of communication technology was relatively high across minority groups, its use appeared to play different roles in different racial/ethnic populations. The Internet and patient portals showed no particular associations with patient-provider communication except for Black Internet users, who reported poorer experiences with patient-provider communication than non-users. Among Asians and Hispanics, social media and mobile communication appeared to play different roles in impacting communication experiences with health care providers. The findings suggest that communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities.

Psychosocial Factors Are Associated with Electronic Portal Registration

BACKGROUND

Electronic health records often include a portal for secure patient-clinician communication. There is evidence that use of electronic portals increases satisfaction, treatment adherence, safety, and clinical outcomes. We want everyone to enjoy these benefits and we noticed low and uneven portal use. We studied factors that we can address to improve portal use.

QUESTIONS/PURPOSES

After controlling for differences in patient characteristics, what psychological and demographic factors are associated with an increased likelihood of registering for an electronic health record portal among people seeking musculoskeletal specialty care?

METHODS

We reviewed data on 5672 adult English or Spanish-speaking patients seen in a musculoskeletal specialty office between October 2017 and December 2019. Eighteen percent (996 patients) had missing measures of symptoms of depression and anxiety due to intermittent problems with survey technology, leaving 4676 for analysis, 42% (1970 of 4676) men and 58% (2706 of 4676) women with a mean age of 51±15, 76% (3569 of 4676) of patients were English speaking, 22% (1015 of 4676) were Spanish speaking, and 2% (92 of 4676) spoke another language. Seventy-seven percent (3620 of 4676) of patients were residents of Austin, Texas, USA, 4% (159) were from Pflugerville, Texas, USA, 3% (143) were from Del Valle, Texas, USA, and 16% (754 of 4676) were from other areas of Texas. Ninety nine percent of patients were residents of Texas (4645 of 4676). Twenty-three percent of patients visited the upper extremity team (1077 of 4676), 37% the lower extremity team (1721 of 4676), 21% the back and neck team (1002 of 4676), and 19% the sport medicine team (876 of 4676). Seventy eight percent of patients (3654 of 4676) registered in portal and 22% (1022 of 4676) did not. The omitted population were not different from our study population in terms of age, gender, language, residence, and region of symptoms. We used a two-question measure of symptoms of depression (Patient Health Quality-2 [PHQ-2]) and a two-question measure of symptoms of anxiety (General Anxiety Disorder-2 [GAD-2]). The primary outcome was portal registration. To account for potential confounding, a multivariable logistic regressions model was used to determine the influence of age, spoken language, city and state of residence, care team, number of completed visits and GAD and PHQ scores on portal registration.

RESULTS

After controlling for potentially confounding variables such as state of residence, we found younger age (odds ratio 0.98 [95% CI 0.97 to 0.99]; p < 0.01), speaking English (OR 1.85 [95% CI 1.14 to 3.02]; p = 0.01) rather than Spanish (OR 0.27 [95% CI 0.17 to 0.45]; p < 0.01), seeking care for back or neck symptoms, (OR 3.84 [95% CI 2.60 to 5.66]; p < 0.01) and higher number of completed visits (OR 1.03 [95% CI 1.01 to 1.05]; p < 0.01) were associated with an increased likelihood of portal registration while living in Austin, Texas, USA (OR 0.68 [95% CI 0.53 to 0.87]; p < 0.01) and Del Valle, Texas, USA (OR 0.47 [95% CI 0.30 to 0.74]; p < 0.01) compared with Pflugerville, Texas, USA, or other cities, seeking care for upper extremity (OR 0.74 [95% CI 0.58 to 0.94]; p = 0.01) or lower extremity symptoms (OR 0.68 [95% CI 0.53 to 0.86]; p < 0.01), and greater symptoms of anxiety (GAD score) (OR 0.97 [95% CI 0.95 to 0.99]; p < 0.01) or depression (PHQ score) (OR 0.97 [95% CI 0.95 to 0.98]; p < 0.01) were associated with lower likelihood of registering for the portal. English language, city of residence, and seeking care for back or neck symptoms (due to insurance contracts) were all associated with higher socioeconomic status in our setting.

CONCLUSIONS

The association of better mental and social health (financial, employment, housing and food security; connectedness) with registration in a communication portal directs us to be more intentional about efforts to specifically welcome disadvantaged people to participate in the portal and to study the impact and effectiveness of such efforts.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Association Between the Mental Health of Patients With Psoriasis and Their Satisfaction With Physicians

Importance

How patients' mental health is associated with their satisfaction with physicians is rarely studied among adults with skin conditions.

Objective

To examine the association between mental health comorbidities in patients with psoriasis and their satisfaction with physicians.

Design, Setting, and Participants

This retrospective survey analysis used 14 years of nationally representative longitudinal data on adults in the United States with psoriasis from the 2004-2017 Medical Expenditure Panel Survey. Statistical analysis was performed from October 1, 2018, to December 1, 2019. Mental health comorbidities were measured by performance on the Kessler 6-Item Psychological Distress Scale (score range, 0-24, where a score ≥13 is considered an indicator of a serious mental illness and significant psychological distress) and the Patient Health Questionnaire 2 (score range, 0-6, where a score ≥3 is considered a positive screening result for a depressive disorder).

Main Outcomes and Measures

Patient satisfaction with physician, measured by the patient-physician communication composite score.

Results

A weighted total of 8 876 767 US adults with psoriasis (unweighted total, 652 patients) (weighted; 54% women; mean [SEM] age, 52.1 [0.7] years) were analyzed; 27% of adults had moderate or severe symptoms of psychological distress, and 21% had moderate or severe symptoms of depression. Patients with moderate or severe psychological distress symptoms were less satisfied with their clinicians compared with those with no or mild psychological distress symptoms (mean Kessler 6-Item Psychological Distress Scale scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 13.0-13.4]; and severe symptoms, 13.1 [95% CI, 12.5-13.7]; P < .001). In addition, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction (adjusted odds ratio, 2.8 [95% CI, 1.5-4.9]; P = .001), and patients with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction (adjusted odds ratio, 2.3 [95% CI, 1.1-4.7]; P = .03). Furthermore, patients with moderate or severe depression symptoms were less satisfied with their clinicians compared with those with no or mild depression symptoms (mean Patient Health Questionnaire 2 scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 12.9-13.6]; and severe symptoms, 13.0 [95% CI, 12.6-13.4]; P = .002). In addition, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 4.6 times more likely to report low patient satisfaction (adjusted odds ratio, 4.6 [95% CI, 2.1-10.0]; P < .001).

Conclusions and Relevance

This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms. Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.

Disparities in perceived patient-provider communication quality in the United States: Trends and correlates

OBJECTIVE

This study aimed to describe disparities and temporal trends in the level of perceived patient-provider communication quality (PPPCQ) in the United States, and to identify sociodemographic and health-related factors associated with elements of PPPCQ.

METHODS

A cross-sectional analysis was conducted using nationally-representative data from the 2011-2013 iterations of the Health Information National Trends Survey (HINTS). Descriptive statistics, multivariable linear and logistic regression analyses were conducted to examine associations.

RESULTS

PPPCQ scores, the composite measure of patients' ratings of communication quality, were positive overall (82.8; 95% CI: 82.1-83.5). However, less than half (42-46%) of respondents perceived that providers always addressed their feelings, spent enough time with them, or helped with feelings of uncertainty about their health. Older adults and those with a regular provider consistently had higher PPPCQ scores, while those with poorer perceived general health were consistently less likely to have positive perceptions of their providers' communication behaviors.

CONCLUSIONS

Disparities in PPPCQ can be attributed to patients' age, race/ethnicity, educational attainment, employment status, income, healthcare access and general health.

PRACTICE IMPLICATIONS

These findings may inform educational and policy efforts which aim to improve patient-provider communication, enhance the quality of care, and reduce health disparities.