By Daniel Weintraub
California Health Report
Low-income Californians are more likely to feel empowered and engaged in decisions about their health care when they are more informed about their condition and the options available to them, according to a report released Monday.
And patients are more likely to feel informed when they see the same health provider regularly and believe that someone in their doctor’s office or clinic knows them well.
The report by New York-based Langer Research Associates is based on results from a broad-based survey of poor and near-poor Californians conducted earlier this year. The survey of 1,024 people aged 19 to 64 with incomes of less than 200 percent of the federal poverty level was financed by the Blue Shield of California Foundation.
The survey and the latest report on its findings highlight the potential value of “patient-centered care” – one of the key goals of the federal health reform law passed by Congress and President Obama in 2010.
It is widely believed among health care providers and experts that the health of low-income people suffers because they tend to be less likely to see the same doctor on a regular basis and have a personal connection to their doctor’s office or clinic. That lack of continuity can lead to confusion about their course of care and leave patients feeling less empowered in their relationship with their doctor or other provider.
Indeed, the survey results show that patients who feel connected to their health provider and have continuity of care are more likely to be engaged in their own care, which typically leads to better outcomes.
Among patients who feel less informed about their health, just 33 percent report feeling comfortable asking questions of their provider. But that percentage doubles -– to 67 percent – among those who feel informed about their health condition.
And that comfort level extends from asking questions to making decisions. Among those who feel very informed about their health, nearly 7 in 10 also feel very confident in their ability to make decisions about their health care. But among those who feel less than very well informed, just 44 percent express strong confidence in their ability to make decisions.
Finally, patients who feel highly informed about their health are also more likely to say they always understand their providers’ advice and treatment plans. Sixty-one percent of the well informed report always understanding their doctor’s instructions, while just 34 percent of patients who are “somewhat informed” report that level of understanding.
Patients who are uncomfortable asking questions are more likely to misunderstand their provider’s treatment advice. A third of those patients say that they have not followed a provider’s advice or treatment plan because they did not understand what to do. Only 14 percent of those patients who say they are comfortable asking question say there have been times when they did not follow a doctor’s instructions.
Among the other findings:
–Patients who are more comfortable asking questions of their providers, understand their providers’ instructions and are confident in their ability to make decisions are more likely to be involved in their own care.
–Information is key. Among those who feel they lack information about their health, 55 percent say they play a role in their healthcare decisions, but among those who feel very informed, the number who say they play a role increases to 83 percent.
–Feeling informed about their health condition and confident about playing a role in decisions is a stronger predictor of a patient’s level of engagement than their education, income, gender, race or ethnicity, language spoken in the home or the type of health facility they use.
Which patients feel the most informed? People who see private doctors are most likely to report feeling informed about their health, with 58 percent of private patients reporting feeling “very informed.” Next came patients of Kaiser Permanente – at 53 percent. They were followed by patients at Community Clinic and Health Centers (47 percent); other clinics (43 percent). Patients who got most of their care from emergency rooms were the least likely to feel informed about their care, with just 36 percent saying they were “very informed.”
To download a copy of the full report, click here.
Note: The Blue Shield of California Foundation, which funded this research, is also a financial sponsor of HealthyCal.org.