The Relationship between Patient-Centered Medical Home Characteristics and Patient Dissatisfaction at a Federally Qualified Health Center.

This cross-sectional study examined the relationship between patients' assessment of patient-centered medical home (PCMH) characteristics and patient experiences at a federally qualified health center. The survey was based on the Consumer Assessment of Health care Providers and Systems (CAHPS) instrument. Patient-centered medical home characteristics include access to care and coordination, provider communication, office staff helpfulness, and discrimination. Outcomes were related to patient experiences reflecting their dissatisfaction and lack of trust. Our sample (N = 257) was 76% female, 39% older than 50, 40% with college education, and 84% African American. We performed multiple logistic regression to examine the association between PCMH characteristics and patient dissatisfaction, adjusting for demographics. Approximately 26% of the participants reported dissatisfaction with at least one outcome. Effective provider communication was the primary contributor to decreased odds of patient dissatisfaction and lack of trust. The study highlights the prominence of provider communication for patients using safety-net providers.

Patient-centered communication: dissecting provider communication.

PURPOSE: The purpose of this paper is to examine the relationship between patients' provider communication effectiveness and courteousness with patients' satisfaction and trust at free clinics. DESIGN/METHODOLOGY/APPROACH: This cross-sectional survey (n=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics. FINDINGS: Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness. PRACTICAL IMPLICATIONS: Investment in patient-centered communication training for providers will improve patient satisfaction and trust. ORIGINALITY/VALUE: The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.

Hispanics' Satisfaction with Free Clinic Providers: An Analysis of Patient-Centered Medical Home Characteristics.

Hispanic Americans are less likely to be insured and they experience cultural and linguistic barriers that may prevent them from obtaining necessary and preventive healthcare. Adoption of Patient Centered Medical Home (PCMH) concepts in healthcare settings utilized by Hispanics could improve Hispanic patients' satisfaction with their healthcare providers. This study examined the association between Spanish-speaking and non-Spanish-speaking patients' perceptions of PCMH characteristics and satisfaction with the provider. Data were collected using a self-administered survey from two unaffiliated free clinics. Logistic regression modeled the associations between patients' perceptions of PCMH and their satisfaction with their provider, and their desire to see the same provider in the future. The sample consisted of 367 adults; 44 % were Spanish-speaking. Spanish-speaking patients were younger, less educated, and had fewer chronic conditions than non-Spanish-speaking patients. In adjusted analyses for each population, better ratings of the provider's communication skills were associated with increased satisfaction with the provider (Spanish-speaking: OR = 8.33, 95 % CI = 2.19-31.76; non-Spanish-speaking: OR = 31.39, 95 % CI = 6.91-142.62), and willingness to see the provider again (Spanish-speaking: OR = 12.54, 95 % CI = 2.80-56.24; non-Spanish-speaking: OR = 8.77, 95 % CI = 2.40-31.96). Among Spanish-speakers, lower perceived discrimination was associated with 137 % increased odds and higher perceived staff helpfulness had 212 % increased odds of seeing the provider again. Relative to other PCMH components, interpersonal skills were the most important factors in patient satisfaction with free clinics. Increased training for clinicians on cultural competence and clinician-patient communication may lead to improved patient satisfaction for both Spanish and non-Spanish speakers seen at free clinics, particularly clinics in states without Medicaid expansion.

Race, socioeconomic status, health-related quality of life, and self-care of type 2 diabetes mellitus among adults in North Carolina.

OBJECTIVES: The objective of this study was to examine the associations among race, education, income, and health-related quality of life (HRQoL) in self-care of type 2 diabetes mellitus among adults in North Carolina. METHODS: A secondary analysis was conducted using data from the 2009 Behavioral Risk Factor Surveillance Survey (BRFSS), a large population-based survey (N = 432,607) conducted in the United States. The data were analyzed to account for the weighted complex multistage sampling design of the Behavioral Risk Factor Surveillance Survey. Parametric testing using univariate/bivariate/multivariate analysis was performed. RESULTS: The majority of participants reported taking a class/course on diabetes mellitus management and having checked their blood glucose levels at least once per day. The majority (61.26%) of the participants did not have good self-management skills, based on the education and blood glucose-monitoring criteria established for this study. Participants with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices. CONCLUSIONS: Individuals with poor HRQoL had significantly increased odds of good diabetes mellitus self-care practices. Although findings on race, education, and income were not statistically significant, they were consistent with previous research. In the future, individuals who are nonwhite, have less than a high school level of education, and have no health insurance should be targeted to improve diabetes mellitus self-care practices through educational and informational materials. Further investigation using more comprehensive measures of diabetes mellitus self-care is warranted.

Is breakfast skipping associated with physical activity among U.S. adolescents? A cross-sectional study of adolescents aged 12-19 years, National Health and Nutrition Examination Survey (NHANES).

OBJECTIVE: To examine the association between breakfast skipping and physical activity among US adolescents aged 12-19 years. DESIGN: A cross-sectional study of nationally representative 2007-2008 National Health and Nutrition Examination Survey (NHANES) data. SETTING: Breakfast skipping was assessed by two 24 h dietary recalls. Physical activity was self-reported by participants and classified based on meeting national recommendations for physical activity for the appropriate age group. Multiple logistic regression analysis was used to model the association between breakfast skipping and physical activity while controlling for confounders. SUBJECTS: A total of 936 adolescents aged 12-19 years in the USA. RESULTS: After adjusting for family income, there was no association between breakfast skipping and meeting physical activity guidelines for age among adolescents aged 12-19 years (OR = 0.95, 95% CI 0.56, 1.32). CONCLUSIONS: Findings from the study differ from previous research findings on breakfast skipping and physical activity. Therefore, further research that uses large, nationally representative US samples and national recommended guidelines for physical activity is needed.

Racial influences on diabetes management among adults in North Carolina.

OBJECTIVE: To examine the impact race and socioeconomic status (SES) has on diabetes management among adults in North Carolina. DESIGN: Our study utilized data from the 2008 BRFSS to conduct a retrospective study and secondary data analysis. To account for the multistage survey design of BRFSS, SAS/SUDAAN was used to calculate adjusted and unadjusted odds ratios and 95% confidence intervals (CIs). Multiple regression analysis was performed to examine the impact race and SES has on diabetes management among North Carolina adults. RESULTS: The majority of the participants (63.34%) did not have good diabetes management based on the education and blood glucose criteria of our study. Non-Whites had higher odds than Whites to have good diabetes management practices (OR = 1.56, CI: 1.19, 2.03). Individuals who were low SES had poorer diabetes management than individuals who were identified as being high SES (OR = .81, CI: .60, 1.09). CONCLUSIONS: Disparities in good diabetes management practices were found among the variables of race, and SES. Findings from the study indicate that non-White adults had higher odds of good diabetes management practices than Whites in North Carolina. The results of this study could be used for policies and recommendations for health organizations. If health insurance policies required diabetes education classes a reduction in diabetes complications may be observed. Future studies should have a more accurate measurement of diabetes management; proxy measures were used in this study that relied on self-report and may not have provided the best measurement for diabetes management.

Effects of social ties on self-rated physical health among African American adults.

OBJECTIVES: To examine associations between social ties and self-rated physical health among midlife and older African Americans. METHODS: Cross-sectional analysis of the 2005-2006 Milwaukee African American oversample of the second Midlife Development in the United States (MIDUS II) study. Multivariate logistic regression examined associations between type of social ties (family or friends), their frequency (number of contacts), and their quality (support and strain) with betterself-rated physical health (SRPH). We defined better SRPH to include self-reports of good, very good, or excellent SRPH: this category was compared with fair or poor SRPH. Control variables included demographic factors; social engagement characteristics such as working, volunteering, and caregiving; and measures of social structure such as types of discrimination experience and ratings of neighborhood quality. RESULTS: In adjusted results, each additional degree of family support was associated with better self-rated physical health (odds ratio [OR], 1.59; 95% confidence interval (CI], 1.14-2.22). Each additional reported incident of daily discrimination was associated with 9% lower odds of reporting better SRPH (OR, 0.91; CI, 0.83-0.99). DISCUSSION: Results suggest quality of family support may contribute importantly to the health of African Americans. When working with midlife and older African Americans, providers should engage and support families as a vital resource to improve health.

Challenges and opportunities in recruiting and retaining underrepresented populations into health promotion research.

PURPOSE: To evaluate how recruitment strategies and program characteristics interact with participant characteristics to influence recruitment and retention in an exercise intervention study targeted to African American and White older adults with multiple chronic illnesses. DESIGN AND METHODS: Characteristics of 273 referrals and 103 enrollees were analyzed in conjunction with programmatic decisions about recruitment design and eligibility criteria. RESULTS: Eligible participants who did not enroll were younger and more likely to be under 60 and to self-report having diabetes. After 1 year, 70% of the enrolled participants remained in the program. Program attrition was not associated with randomization, race, or chronic illness but was associated with functional status, having a high school degree, and program site. IMPLICATIONS: Program design decisions can significantly influence the participation of underrepresented populations in exercise health promotion programs for older adults. In particular, group-specific efforts targeted to recruiting and retaining African Americans can be successful.