Patient Experience with Primary Care Physician and Risk for Hospitalization in Hispanics with CKD

Abstract

Background and objectivesIn the general population, the quality of the patient experience with their primary care physician may influence health outcomes but this has not been evaluated in CKD. This is relevant for the growing Hispanic CKD population, which potentially faces challenges to the quality of the patient experience related to language or cultural factors. We evaluated the association between the patient experience with their primary care physician and outcomes in Hispanics with CKD.Design, setting, participants, & measurementsThis prospective observational study included 252 English- and Spanish-speaking Hispanics with entry eGFR of 20–70 ml/min per 1.73 m2, enrolled in the Hispanic Chronic Renal Insufficiency Cohort study between 2005 and 2008. Patient experience with their primary care physician was assessed by the Ambulatory Care Experiences Survey subscales: communication quality, whole-person orientation, health promotion, interpersonal treatment, and trust. Poisson and proportional hazards models were used to assess the association between the patient experience and outcomes, which included hospitalization, ESKD, and all-cause death.ResultsParticipants had a mean age of 56 years, 38% were women, 80% were primary Spanish speakers, and had a mean eGFR of 38 ml/min per 1.73 m2. Over 4.8 years (median) follow-up, there were 619 hospitalizations, 103 ESKD events, and 56 deaths. As compared with higher subscale scores, lower scores on four of the five subscales were associated with a higher adjusted rate ratio (RR) for all-cause hospitalization (communication quality: RR, 1.54; 95% confidence interval [95% CI], 1.25 to 1.90; health promotion: RR, 1.31; 95% CI, 1.05 to 1.62; interpersonal treatment: RR, 1.50; 95% CI, 1.22 to 1.85; and trust: RR, 1.57; 95% CI, 1.27 to 1.93). There was no significant association of subscales with incident ESKD or all-cause death.ConclusionsLower perceived quality of the patient experience with their primary care physician was associated with a higher risk of hospitalization.

Barriers in Healthcare for Latinx Patients with Limited English Proficiency—a Narrative Review

“…These challenges lead to later hospital presentation, low healthcare utilization, and poor outcomes. 4,11,29,42,64,65 The US healthcare system finds itself in an unfortunate cycle with some of its most socially marginalized patients. Additional research is needed; however, it may be challenging to conduct research on the Latinx community given reports of mistrust of medical researchers.…”

“…A survey that assessed satisfaction among Latinx patients with LEP and kidney disease reported an association between poor patient clinic satisfaction and increased risk of hospitalization which could not otherwise be explained by medication nonadherence, hemoglobin A1c, or blood pressure. 4 Poor patient satisfaction can also affect patients' access to care. Interviews with patients with LEP demonstrated that compared to patients with high satisfaction, those with low satisfaction were less likely to return to the emergency department for care.…”

Emergency Department/Urgent Care as Usual Source of Care and Clinical Outcomes in CKD: Findings From the Chronic Renal Insufficiency Cohort Study

“…30 Any hospitalizations falling within a "disease of the circulatory system" category was designated as cardiovascular; all others were deemed non-cardiovascular. 31 Ascertainment of ESKD was supplemented by cross-linkage with the US Renal Data System. Deaths were ascertained from reports by next of kin, death certificates, hospital records, and linkage with the Social Security Death Master File.…”

Structural Inequities and Barriers to Accessing Kidney Healthcare Services in the United States: A Focus on Uninsured and Undocumented Children and Young Adults

“…Even when they have insurance coverage, the majority of these patients depend on primary care providers (PCP) for kidney-related care as a result of limited access to nephrologists. Unfortunately, there is often suboptimal quality of CKD education during encounters with PCP in the localities in which marginalized populations live ( 42 – 44 ). It is, therefore, necessary to work with community PCP to enhance their knowledge about the nature and complications associated with kidney disease.…”