By Melinda Young
Communication between providers and patients declined from 2013 to 2019 among older adults, especially among those with multiple chronic conditions, according to recent research. The decline occurred across all racial groups, but was particularly noticeable among non-Hispanic white patients.1
“From beginning to end, it trended down,” says Mary Lynn Davis-Ajami, PhD, MBA, FNP, RN, lead study author and a professor and associate dean of academic affairs at Michigan State University College of Nursing.
Davis-Ajami and colleagues, using data from the Medical Expenditure Panel Survey self-administered questionnaire, analyzed patients’ responses about four communication indicators, including:
- Providers listened carefully to patients;
- Providers explained things in a way that was easy to understand;
- Providers showed respect for what patients had to say;
- Providers spent enough time with patients.
Patients expressed the least amount of satisfaction with the time their provider spent with them.
When data were divided into four groups — Hispanic, non-Hispanic white, non-Hispanic Black, and Asian and other races — Davis-Ajami and colleagues found some differences in satisfaction with provider-patient communication.
For example, the group of people who identified as Asian or other races reported the lowest rates of satisfaction with how their provider explained things, showed respect, or spent enough time.
“We saw some improvements with the Black population, but the area of the highest concern and the areas with the lowest response of being always or most were with the Asian population,” Davis-Ajami explains.
This highly complex patient population is often seen by case managers and care coordinators to manage chronic conditions, such as diabetes, hypertension, and many others. Patients must understand their conditions and self-management, so provider communication is crucial to their health.
“Those within the sample that had the best perception of their health status, whether physical or mental, had the best perception of provider communication,” Davis-Ajami says. “What that tells me is that for those who are highly complex and they’re either physically or mentally not in great shape, they may have a need for more elaboration, more detail from providers.”
These at-risk patients may not understand what their clinician says the first time they hear it. They may even experience confusion about what they were told after discharge. This suggests providers need a team approach to patient teaching and communication. Nurses, social workers, case managers, and others can help reinforce the physician’s instructions and comments.
Case managers and educators can answer questions patients may not have considered when they were talking with their doctors.
Cultural differences and language differences also could play a role. These should be addressed by providers.
“We didn’t look at whether there was concordance between the provider and patient in terms of race,” Davis-Ajami says. “There are a lot of studies that show if you’re the same racial background, a lot of aspects of the patient appointment go much better, and adherence is better.”
Another possibility is people with multiple chronic conditions expect more from their providers. Patients might need more time to discuss their conditions, and expect physicians to make time for them. Case managers can help patients adjust their expectations, as well as reinforce education and communication. They also can take time to build trust with patients.
“When the patient leaves the doctor’s presence, whether it’s in the hospital or an office, there is a vulnerable window or time when the information is recent,” Davis-Ajami explains. “Someone could sit down with the patient and say, ‘Tell me about your understanding of what the treatment plan is. Do you know your medications?’”
The case manager could read the provider’s treatment notes to reinforce the prescribed treatment and to answer patients’ questions. “If patients’ family members are present, there might be more of an opportunity to draw the family in to the discussion,” Davis-Ajami says. “From there, the case manager could make a plan between what happened at the appointment with the provider and this post-appointment conversation. They could triage additional support, whether it’s a pharmacy consultation, dietitian, nurse educator, or home health.”
They also could return to the provider if the patient asks questions about that interaction. “That’s the kind of thing I’d like to see in care models for complex care management,” Davis-Ajami says. “It’s a team approach with different disciplines in the office.” Case management can help patients find community resources and learn about barriers to patients’ self-management because they spend a little more time with them.
Health systems could include these same four communication questions in their surveys to reinforce the importance of provider-patient communication and to catch systemic problems. If an organization identifies racial differences in how patients answer communication questions, then they can set up a racially diverse team to work with patients.
“We need to pay attention to all racial parts of our demographics in the country so it’s more equitable and you don’t see differences between the races on communication,” Davis-Ajami says.
REFERENCE
- Davis-Ajami ML, Lu ZK, Wu J. US older adults with multiple chronic conditions perceptions of provider-patient communication: Trends and racial disparities from MEPS 2013-2019. J Gen Intern Med 2023;38:1459-1467.
Communication between providers and patients declined from 2013 to 2019 among older adults, especially among those with multiple chronic conditions, according to recent research. The decline occurred across all racial groups, but was particularly noticeable among non-Hispanic white patients.
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