Ng Nicole, Purkayastha Subhanik, Ying Xiaohan, Jesudian Arun, Rosenblatt Russell
Department of Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell, New York, NY, USA.
Weill Cornell Medical College, New York, NY, USA.
Dig Dis Sci. 2025 Sep 6. doi: 10.1007/s10620-025-09374-4.
Suboptimal patient-provider relationship is a significant contributor to healthcare disparities. Minority populations report fewer favorable interactions, which may lead to poorer outcomes and engagement in care. Patients with chronic diseases are especially at risk.
We aimed to study perceptions of healthcare providers and experience among those with cirrhosis.
The nationally representative database, All of Us, was queried. The primary outcome was "favorable healthcare experiences," defined as whether providers asked for opinions, demonstrated respect, and were easy to understand. The secondary outcome was "unfavorable healthcare experiences," defined as whether patients felt they were treated with less courtesy, received poorer service, or not listened to. We compared the experience between income levels and other demographic variables. Multivariable logistic regression was adjusted for a priori covariates.
5753 patients with cirrhosis were included with a mean age of 58. The majority were male (51%), White (52%), and US-born (84%). On multivariable analysis, compared to those earning > $150 k annually, participants with $10-35 k and < $10 k reported significantly lower odds of finding providers easy to understand (OR 0.40 [0.17-0.96] and OR 0.37 [0.15-0.94], respectively) and higher odds of feeling they were treated with less courtesy (OR 3.10 [1.06-9.03] and OR 4.13 [1.30-13.1], respectively). After further controlling for education, participants with an annual income of $10-35 k and < $10 k still reported higher odds of feeling they received poorer service than others (OR 3.87 [1.09-13.71] and OR 5.01 [1.26-19.8], respectively). Compared to men, women felt that they were not listened to (OR 1.90 [1.37-2.63]).
Patients with cirrhosis from various backgrounds report significantly different experiences with providers. Notably, those with lower income endorsed more unfavorable interactions. We identified areas for interventions to strengthen the patient-provider relationship among patients with chronic liver disease.
患者与医疗服务提供者之间的关系欠佳是导致医疗保健差异的一个重要因素。少数族裔人群报告称与医疗服务提供者的良好互动较少，这可能导致较差的治疗结果和较低的医疗参与度。慢性病患者尤其面临风险。
我们旨在研究肝硬化患者对医疗服务提供者的看法及就医体验。
查询了具有全国代表性的“我们所有人”数据库。主要结局是“良好的医疗体验”，定义为医疗服务提供者是否征求意见、表现出尊重以及是否易于理解。次要结局是“不良的医疗体验”，定义为患者是否觉得自己受到的礼遇较少、得到的服务较差或未被倾听。我们比较了不同收入水平和其他人口统计学变量之间的体验差异。多变量逻辑回归针对先验协变量进行了调整。
纳入了5753例肝硬化患者，平均年龄为58岁。大多数为男性（51%）、白人（52%）且出生于美国（84%）。在多变量分析中，与年收入超过15万美元的患者相比，年收入在1万至3.5万美元以及低于1万美元的参与者表示，认为医疗服务提供者易于理解的几率显著较低（分别为OR 0.40 [0.17 - 0.96]和OR 0.37 [0.15 - 0.94]），而觉得自己受到的礼遇较少的几率较高（分别为OR 3.10 [1.06 - 9.03]和OR 4.13 [1.30 - 13.1]）。在进一步控制教育因素后，年收入在1万至3.5万美元以及低于1万美元的参与者仍表示，觉得自己得到的服务比其他人差的几率较高（分别为OR 3.87 [1.09 - 13.71]和OR 5.01 [1.26 - 19.8]）。与男性相比，女性觉得自己未被倾听（OR 1.90 [1.37 - 2.63]）。
来自不同背景的肝硬化患者报告的与医疗服务提供者的体验存在显著差异。值得注意的是，低收入患者认可更多不良互动。我们确定了一些干预领域，以加强慢性肝病患者与医疗服务提供者之间的关系。
