DeVoe Jennifer E, Wallace Lorraine S, Fryer George E
Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
Health Expect. 2009 Mar;12(1):70-80. doi: 10.1111/j.1369-7625.2008.00516.x.
National governments across the globe have set goals to improve healthcare delivery. Understanding patient-provider communication is essential for the development of policies that measure how well a healthcare system delivers care.
This study was designed to determine which, if any, demographic factors were independently associated with how US patients perceive various aspects of communication with their healthcare providers.
The study was a secondary, cross-sectional analysis of nationally representative data from the 2002 Medical Expenditure Panel Survey (MEPS). Among US adults with a healthcare visit in the past year (n = approximately 16,700), we assessed the association between several covariate demographic and socioeconomic factors and four dependent measures of patient perceptions of communication with their healthcare providers.
Across all four measures of communication, older patients were more likely to report positively. Having health insurance and a usual source of care were consistent predictors of positive perceptions of communication. Hispanic patients also reported better perceptions of communication across all four measures. The most economically disadvantaged patients were less likely to report that providers always explained things so that they understood. Male patients were more likely to report that providers always spent enough time with them.
This study suggests that patient perceptions of communication in healthcare settings vary widely by demographics and other individual patient characteristics. In this paper, we discuss the relevance of these communication disparities to design policies to improve healthcare systems, both at the individual practice level and the national level.
全球各国政府都设定了改善医疗服务的目标。了解患者与医疗服务提供者之间的沟通对于制定衡量医疗系统提供医疗服务水平的政策至关重要。
本研究旨在确定哪些人口统计学因素(如果有的话)与美国患者对与医疗服务提供者沟通的各个方面的看法独立相关。
该研究是对2002年医疗支出面板调查(MEPS)的全国代表性数据进行的二次横断面分析。在过去一年中有过医疗就诊经历的美国成年人(n = 约16,700)中,我们评估了几个协变量人口统计学和社会经济因素与患者对与医疗服务提供者沟通的看法的四个相关测量指标之间的关联。
在所有四个沟通测量指标中,老年患者更有可能给出积极评价。拥有医疗保险和固定的医疗服务来源是对沟通有积极看法的一致预测因素。西班牙裔患者在所有四个指标上对沟通的评价也更好。经济上最弱势的患者不太可能报告医疗服务提供者总是解释得让他们能理解。男性患者更有可能报告医疗服务提供者总是与他们共度足够的时间。
本研究表明,患者对医疗环境中沟通的看法因人口统计学和其他个体患者特征而有很大差异。在本文中,我们讨论了这些沟通差异与设计改善医疗系统政策的相关性,包括在个体医疗实践层面和国家层面。