Hispanics’ Satisfaction with Free Clinic Providers: An Analysis of Patient-Centered Medical Home Characteristics

Abstract

Hispanic Americans are less likely to be insured and they experience cultural and linguistic barriers that may prevent them from obtaining necessary and preventive healthcare. Adoption of Patient Centered Medical Home (PCMH) concepts in healthcare settings utilized by Hispanics could improve Hispanic patients' satisfaction with their healthcare providers. This study examined the association between Spanish-speaking and non-Spanish-speaking patients' perceptions of PCMH characteristics and satisfaction with the provider. Data were collected using a self-administered survey from two unaffiliated free clinics. Logistic regression modeled the associations between patients' perceptions of PCMH and their satisfaction with their provider, and their desire to see the same provider in the future. The sample consisted of 367 adults; 44 % were Spanish-speaking. Spanish-speaking patients were younger, less educated, and had fewer chronic conditions than non-Spanish-speaking patients. In adjusted analyses for each population, better ratings of the provider's communication skills were associated with increased satisfaction with the provider (Spanish-speaking: OR = 8.33, 95 % CI = 2.19-31.76; non-Spanish-speaking: OR = 31.39, 95 % CI = 6.91-142.62), and willingness to see the provider again (Spanish-speaking: OR = 12.54, 95 % CI = 2.80-56.24; non-Spanish-speaking: OR = 8.77, 95 % CI = 2.40-31.96). Among Spanish-speakers, lower perceived discrimination was associated with 137 % increased odds and higher perceived staff helpfulness had 212 % increased odds of seeing the provider again. Relative to other PCMH components, interpersonal skills were the most important factors in patient satisfaction with free clinics. Increased training for clinicians on cultural competence and clinician-patient communication may lead to improved patient satisfaction for both Spanish and non-Spanish speakers seen at free clinics, particularly clinics in states without Medicaid expansion.

Continuity of Care: Perspectives of Uninsured Free Clinic Patients

“…Free clinic patients feel that they may not be able to see a provider in a timely manner if they see the same provider every visit because volunteer providers do not necessarily see patients regularly (11). Continuity of care can be very important for patient satisfaction among free clinic patients because interpersonal communications with health-care providers influences care and outcomes (12,13). Yet, since few studies have examined the issue of continuity of care at free clinics, The information about this issue on this topic is very limited.…”

Organizational Factors in Patient-Centered Medical Home Implementation and Chronic Disease Management in HRSA-Funded Community Health Centers

“…The Patient-Centered Medical Home (PCMH) model has increasingly attracted the attention of health organizations in the United States as an approach with the potential to improve health outcomes among those with chronic disease, improve quality of care, and reduce health care costs (Martsolf et al, 2012). This health care model promotes the delivery of patient-centered, comprehensive, coordinated, accessible, and evidence-based care, placing emphasis on the whole person, his/her family, and his/her overall well-being (Beacham et al, 2012;Martsolf et al, 2012;Cook et al, 2015;Platonova et al, 2016).…”

“…This model is considered to have the potential to improve health outcomes among those with chronic disease, improve quality of care, enhance patient experience, and reduce health care costs (Martsolf et al, 2012;Setodji et al, 2017). The PCMH model promotes the delivery of patient-centered, comprehensive, coordinated, accessible, and evidence-based care in a culturally competent manner, placing emphasis on the whole person, his/her family, and his/her overall health and well-being (Beacham et al, 2012;Platonova et al, 2016).…”

“…According to Rivo et al (2016), PCMH-related aspects such as comprehensive care, coordinated care, and patient engagement are key to addressing these conditions, as well as managing patient populations. In addition, the model's emphasis on increased accessibility and cultural competence make it highly beneficial for vulnerable and underserved populations (Platonova et al, 2016).…”

“…Case 2 focused on the establishment of what they called a "patient service culture," which included the establishment of a patient service department and a patient service policy for all health center sites. Within a PCMH, these practices are expected to improve the patient's experience and engagement in care (Luxford, Safran & Delbanco, 2011;Beacham et al, 2012;Platonova et al, 2016).…”