Challenges to Understanding and Compliance Among Surgical Patients in Low-Income Urban Teaching Hospitals

Abstract

Financial and educational barriers significantly impact low socioeconomic status racial and ethnic minority groups in their pursuit of health care, though less is known about the interplay of these factors in the pursuit of surgical care. This study was designed to uncover the challenges to patient understanding and compliance with pre- and postsurgical clinical advice in low-income urban environments. The data for this study were collected in spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital in Philadelphia. Survey responses were coded into various groups until categories emerged. Relationships among categories were identified to generate themes and subthemes. Key facilitators of patient understanding and compliance were physician likeability and communication. Eighty (100%) patients reported that the physician always treated them with respect, which was important in their interpretation of their experience with the physician. Eighteen (23%) patients identified a language other than English as their primary language and 57 (71%) patients completed high school or less schooling, which likely influenced their communication with the physician. Eighty (100%) patients expressed that the physician always explained things in a way they could understand, focusing on clarity and thoroughness. Challenges to patient understanding and compliance were finances and social resources. Patients noted difficulty paying for medical care and a lack of support at home. Agency could facilitate use of surgical care while a lack thereof could challenge motivation. Ultimately, these themes showed how patients in this environment interact with surgical care.

Impact of Insurance Type on Access to Pediatric Surgical Care

“…[35][36][37] One study examining a surgical population found that experiences with physicians, communication, finances, social resources, and individual agency impact patient compliance in low-income urban hospitals. 37 Health care institutions, community-based organizations, and providers must acknowledge how these barriers impact patient access to care, and should adopt patientcentered strategies such as easing transportation barriers, reducing wait times, and creating a welcoming environment to intentionally decrease the instances of MCOs. [38][39][40] Previous studies assessing the impact of no-show appointments on the healthcare system found that noshow appointments negatively impact cost, revenue, and use of resources in healthcare systems, as well as decrease provider and clinic productivity, efficiency, and capacity.…”

“…35–37 One study examining a surgical population found that experiences with physicians, communication, finances, social resources, and individual agency impact patient compliance in low-income urban hospitals. 37 Health care institutions, community-based organizations, and providers must acknowledge how these barriers impact patient access to care, and should adopt patient-centered strategies such as easing transportation barriers, reducing wait times, and creating a welcoming environment to intentionally decrease the instances of MCOs. 38–40…”

“…When investigating occurrences of missed appointments in patients with low SES, many of whom have public insurance, studies have found that family obligations, limited work flexibility, and lack of accessible transportation negatively impact appointment attendance. [35][36][37] One study examining a surgical population found that experiences with physicians, communication, finances, social resources, and individual agency impact patient compliance in low-income urban hospitals. 37 Health care institutions, community-based organizations, and providers must acknowledge how these barriers impact patient access to care, and should adopt patientcentered strategies such as easing transportation barriers, reducing wait times, and creating a welcoming environment to intentionally decrease the instances of MCOs.…”

Survival analysis and prognostic model establishment of secondary osteosarcoma: a SEER-based study

“…Studies have shown that economic income is a factor affecting patient compliance 19 . Coats et al 30 found that financial accessibility and acceptance were inversely correlated with treatment abandonment, i.e., the higher income means better compliance, which is consistent with our results.…”

“…In the state of arts, surgery compliance is regarded as a key factor to the prognosis of various diseases 15 – 17 , and thus becomes the focus of social healthcare research 18 , 19 . It is non-negligible that SO rarely happens, according to the clinical statistics.…”