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

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Abstract

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.

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References

  1. Burgen, S. (2015). US now has more spanish speakers than Spain—only Mexico has more. The Guardian.

  2. United States Census Bureau. (2014). Facts for features: Hispanic heritage month 2014. http://www.census.gov/newsroom/facts-for-features/2014/cb14-ff22.html.

  3. Dominguez, K. (2015). Vital signs: Leading causes of death, prevalence of diseases and risk factors, and use of health services among Hispanics in the United States—2009–2013. Morbidity and Mortality Weekly Report, 64, 469–478.

    PubMed  Google Scholar 

  4. Beal, A., Hernandez, S., & Doty, M. (2009). Latino access to the patient-centered medical home. Journal of General Internal Medicine, 24(Suppl 3), 514–520.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jerome-D’Emilia, B., Dunphy Suplee, P., & Gardner, M. R. (2014). Understanding access to care and health needs of Hispanic women from an urban community. Hispanic Health Care International, 12, 71–80.

    Article  PubMed  Google Scholar 

  6. Livingston, G. (2009). Hispanics, health insurance and health care access. Washington: Pew Research Center.

    Google Scholar 

  7. Agency for Healthcare Research and Quality. (2013). National healthcare disparities report. Rockville, MD.

  8. Nelson, A. R., Smedley, B. D., & Stith, A. Y. E. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care Washington. Washington, DC: National Academies Press.

    Google Scholar 

  9. Abramson, C. M., Hashemi, M., & Sanchez-Jankowski, M. (2015). Perceived discrimination in U.S. Healthcare: Charting the effects of key social characteristics within and across racial groups. Preventive Medicine Reports, 2, 615–621.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lee, C., Ayers, S. L., & Kronenfeld, J. J. (2009). The association between perceived provider discrimination, healthcare utilization and health status in racial and ethnic minorities. Ethnicity and Disease, 19, 330–337.

    PubMed  PubMed Central  Google Scholar 

  11. Feinglass, J., Nonzee, N. J., Murphy, K. R., Endress, R., & Simon, M. A. (2014). Access to care outcomes: A telephone interview study of a suburban safety net program for the uninsured. Journal of Community Health, 39, 108–117.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Benjamins, M. R., & Whitman, S. (2014). Relationships between discrimination in health care and health care outcomes among four race/ethnic groups. Journal of Behavioral Medicine, 37, 402–413.

    Article  PubMed  Google Scholar 

  13. Lopez-Cevallos, D. F., Harvey, S. M., & Warren, J. T. (2014). Medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural latinos. Journal of Rural Health, 30, 344–351.

    Article  PubMed  Google Scholar 

  14. National Association of Free and Charitable Clinics. (2015). Supreme court issues ruling on King v. Burwell upholding federal subsidies—work of free and charitable clinics remains critical. http://www.nafcclinics.org/blog/2015-6-25/supreme-court-issues-ruling-king-v-burwell-upholding-federal-subsidies-work-free-char.

  15. Donahue, K. E., Reid, A., Lefebvre, A., Stanek, M., & Newton, W. P. (2015). Tackling the triple aim in primary care residencies: The i3 pop collaborative. Family Medicine, 47, 91–97.

    PubMed  Google Scholar 

  16. Hall, M. A. (2011). Access to care provided by better safety net systems for the uninsured: Measuring and conceptualizing adequacy. Medical Care Research and Review, 68, 441–461.

    Article  PubMed  Google Scholar 

  17. Ellett, J. D., Campbell, J. A., & Gonsalves, W. C. (2010). Patient satisfaction in a student-run free medical clinic. Family Medicine, 42, 16–18.

    PubMed  Google Scholar 

  18. Illinois Association of Free and Charitable Clinics. (2011). The state of free and charitable clinics in Illinois. http://www.illinoisfreeclinics.org/sites/www.illinoisfreeclinics.org/files/assets/IAFCC-TheStateofFreeAndCharitableClinics-Final-20111114.pdf.

  19. AAFP. (2007). Joint principles of the patient-centered medical home. http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf, 2016.

  20. Davis, K., Abrams, M., & Stremikis, K. (2011). How the affordable care act will strengthen the nation’s primary care foundation. Journal of General Internal Medicine, 26, 1201–1203.

    Article  PubMed  PubMed Central  Google Scholar 

  21. US Department of Health and Human Services. (2014). The affordable care act supports patient-centered medical homes in health centers. http://www.hhs.gov/about/news/2014/08/26/the-affordable-care-act-supports-patient-centered-medical-homes-in-health-centers.html.

  22. Maeng, D. D., Davis, D. E., Tomcavage, J., Graf, T. R., & Procopio, K. M. (2013). Improving patient experience by transforming primary care: Evidence from geisinger’s patient-centered medical homes. Population Health Management, 16, 157–163.

    Article  PubMed  Google Scholar 

  23. Moore, A. D., Hamilton, J. B., Pierre-Louis, B. J., & Jennings, B. M. (2013). Increasing access to care and reducing mistrust: Important considerations when implementing the patient-centered medical home in army health clinics. Military Medicine, 178, 291–298.

    Article  PubMed  Google Scholar 

  24. Wetmore, S., Boisvert, L., Graham, E., et al. (2014). Patient satisfaction with access and continuity of care in a multidisciplinary academic family medicine clinic. Canadian Family Physician, 60, e230–e236.

    PubMed  PubMed Central  Google Scholar 

  25. Nocon, R. S., Gao, Y., Gunter, K. E., et al. (2014). Associations between medical home characteristics and support for patient activation in the safety net: Understanding differences by race, ethnicity, and health status. Medical Care, 52, S48–S55.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Aysola, J., Werner, R. M., Keddem, S., SoRelle, R., & Shea, J. A. (2015). Asking the patient about patient-centered medical homes: A qualitative analysis. Journal of General Internal Medicine, 30, 1461–1467.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Burnet, D., Gunter, K. E., Nocon, R. S., et al. (2014). Medical home characteristics and the pediatric patient experience. Medical Care, 52, S56–S63.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mohanty, S., Kinnier, C. V., & Bilimoria, K. Y. (2015). Patient satisfaction, outcomes, and the need for cancer-specific quality metrics. Journal of the National Cancer Institute. doi:10.1093/jnci/dju438.

    PubMed  Google Scholar 

  29. Mercieca, C., Cassar, S., & Borg, A. A. (2014). Listening to patients: Improving the outpatient service. International Journal of Health Care Quality Assurance, 27, 44–53.

    Article  PubMed  Google Scholar 

  30. Dang, B. N., Westbrook, R. A., Black, W. C., Rodriguez-Barradas, M. C., & Giordano, T. P. (2013). Examining the link between patient satisfaction and adherence to HIV care: A structural equation model. PLoS ONE, 8, e54729.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Roncoroni, J., Tucker, C. M., Wall, W., Nghiem, K., Wheatley, R. S., & Wu, W. (2014). Patient perceived cultural sensitivity of clinic environment and its association with patient satisfaction with care and treatment adherence. American Journal of Lifestyle Medicine. doi:10.1177/1559827614521760.

  32. Glickman, S. W., Boulding, W., Manary, M., et al. (2010). Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 3, 188–195.

    Google Scholar 

  33. Sacks, G. D., Lawson, E. H., Dawes, A. J., et al. (2015). Relationship between hospital performance on a patient satisfaction survey and surgical quality. JAMA Surgery, 150, 858–864.

    Article  PubMed  Google Scholar 

  34. Srinivas, R., Chavin, K. D., Baliga, P. K., Srinivas, T., & Taber, D. J. (2015). Association between patient satisfaction and outcomes in kidney transplant. American Journal of Medical Quality, 30, 180–185.

    Article  PubMed  Google Scholar 

  35. Manary, M. P., Boulding, W., Staelin, R., & Glickman, S. W. (2013). The patient experience and health outcomes. New England Journal of Medicine, 368, 201–203.

    Article  CAS  PubMed  Google Scholar 

  36. Witters, D. (2015). Arkansas, kentucky see most improvement in uninsured rates. Gallup http://www.gallup.com/poll/181664/arkansas-kentucky-improvement-uninsured-rates.aspx?utm_source=tagrss&utm_medium=rss&utm_campaign=syndication.

  37. Bell, A. (2015, June 25). Mecklenburg’s hispanic growth rate still booming, new census records show. The Charlotte Observer, Local.

  38. Artiga, S., Damico, A., & Garfield, R. (2015). Estimates of eligibility for aca coverage among the uninsured by race and ethnicity. Menlo Park, CA: Kaiser Family Foundation.

  39. National Health Policy Forum. (2014). Consumer assessment of healthcare providers and systems (CAHPS) surveys: Assessing patient experience. Washington, DC: The George Washington University.

    Google Scholar 

  40. Agency for Healthcare Research and Quality. (2011). CAHPS clinician and group surveys, version 2.0. Rockville, MD: AHRQ.

    Google Scholar 

  41. Gertz, A. M., Frank, S., & Blixen, C. E. (2011). A survey of patients and providers at free clinics across the united states. Journal of Community Health, 36, 83–93.

    Article  PubMed  Google Scholar 

  42. Livingston, G., Minushkin, S., & Cohn, D. (2008). Hispanics and health care in the United States: Access, information and knowledge. Washington, DC: Pew Research Center.

    Google Scholar 

  43. O’Brien, M., & Shea, J. (2011). Disparities in patient satisfaction among Hispanics: The role of language preference. Journal of Immigrant and Minority Health, 13, 408–412.

    Article  PubMed  Google Scholar 

  44. Villani, J., & Mortensen, K. (2014). Decomposing the gap in satisfaction with provider communication between english- and spanish-speaking Hispanic patients. Journal of Immigrant and Minority Health, 16, 195–203.

    Article  PubMed  Google Scholar 

  45. Cook, N., Hollar, L., Isaac, E., Paul, L., Amofah, A., & Shi, L. (2015). Patient experience in health center medical homes. Journal of Community Health, 40, 1155–1164.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Pandey, S. K., Cantor, J. C., & Lloyd, K. (2014). Immigrant health care access and the affordable care act. Public Administration Review, 74, 749–759.

    Article  Google Scholar 

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Acknowledgments

We would like to thank the patients, providers and staff of our participating clinics. This work was supported in part by funds from the University of North Carolina at Charlotte.

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Correspondence to Jan Warren-Findlow.

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Platonova, E., Warren-Findlow, J., Saunders, W.J. et al. Hispanics’ Satisfaction with Free Clinic Providers: An Analysis of Patient-Centered Medical Home Characteristics. J Community Health 41, 1290–1297 (2016). https://doi.org/10.1007/s10900-016-0218-2

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  • DOI: https://doi.org/10.1007/s10900-016-0218-2

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