School of Nursing and Health Sciences, Merrimack College, North Andover, MA, USA.
University of South Carolina College of Pharmacy, Columbia, SC, USA.
J Gen Intern Med. 2023 May;38(6):1459-1467. doi: 10.1007/s11606-022-07899-2. Epub 2022 Nov 9.
Multiple chronic conditions (MCC) require complex patient-centered approaches with effective provider-patient communication.
To describe trends in patient perceptions of provider-patient communication during non-emergency care and identify associated racial disparities in US older adults with MCC.
DESIGN, SETTING, PARTICIPANTS: Observational study using pooled US Medical Expenditure Panel Survey (2013-2019) data included adults > 65 with two or more chronic conditions.
Provider-patient communication was measured by four indicators (how often their doctor explained things clearly, listened carefully, showed respect, and spent enough time with them). The primary outcomes were the annual rates of reporting "always" for the communication indicators. Cochran-Armitage trend tests examined the trends of reporting "always" and associated racial disparities. Multivariable logistic regression identified racial and other factors associated with respondents choosing "always" for one or more categories for provider-patient communication, defined as positive communication.
Among 9758 older adults with MCC, declining trends for positive communication were shown across all provider-patient communication categories during 2013 to 2019 (p<0.001). The greatest decrease occurred in "always listening carefully", from 68.6% in 2013 to 59.1% in 2019 (p<0.001). The declining trends of four communication measures in non-Hispanic Whites with MCC were significant (p<0.001). Older adults from Hispanic or Non-Hispanic Black racial backgrounds were 28 to 51% more likely to report "always" for the four indicators of provider-patient communication than non-Hispanic Whites after adjusting for respondents' characteristics.
The rates of "always" reporting positive communication with providers significantly declined from 2013 to 2019 in older adults with MCC, particularly in non-Hispanic Whites. Hispanics and non-Hispanic Blacks were more likely to report positive communication with providers than other races.
多种慢性疾病（MCC）需要以患者为中心的复杂方法，并辅以有效的医患沟通。
描述美国患有 MCC 的老年患者在非紧急情况下对医患沟通的看法的变化趋势，并确定相关的种族差异。
设计、地点、参与者：本观察性研究使用了美国医疗支出调查（2013-2019 年）的数据，纳入了 65 岁以上且患有两种或两种以上慢性疾病的成年人。
医患沟通通过四个指标进行衡量（医生解释得是否清楚、是否仔细倾听、是否尊重患者、是否花了足够的时间与患者交流）。主要结果是报告沟通指标“总是”的年度率。Cochran-Armitage 趋势检验用于检验报告“总是”的趋势和相关的种族差异。多变量逻辑回归确定了与选择医患沟通一个或多个类别为“总是”（定义为积极沟通）相关的种族和其他因素。
在 9758 名患有 MCC 的老年患者中，2013 年至 2019 年期间，所有医患沟通类别中积极沟通的趋势均呈下降趋势（p<0.001）。“总是仔细倾听”的下降幅度最大，从 2013 年的 68.6%降至 2019 年的 59.1%（p<0.001）。非西班牙裔白人群体中，四项沟通措施的下降趋势具有统计学意义（p<0.001）。在调整了受访者特征后，西班牙裔或非西班牙裔黑人群体报告四项医患沟通指标“总是”的可能性比非西班牙裔白人高 28%至 51%。
患有 MCC 的老年患者自 2013 年以来，对与提供者保持积极沟通的报告率显著下降，尤其是在非西班牙裔白人群体中。西班牙裔和非西班牙裔黑人更有可能报告与提供者保持积极沟通。
