The Relationship Between Multimorbidity and Patients’ Ratings of Communication

Fung, Constance H.; Setodji, Claude Messan; Kung, Fuan-Yue; Keesey, Joan; Asch, Steven M.; Adams, John; McGlynn, Elizabeth A.

doi:10.1007/s11606-008-0602-4

Cited by 49 publications

(57 citation statements)

References 30 publications

(31 reference statements)

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“…Contrary to previous work linking poor health status to worse interpersonal care, 34,59 we found little evidence of the independent influence of BP control (as a proxy for health status) on communication. Patients may not consider BP control as indicative of their overall health status.…”

Section: Discussioncontrasting

confidence: 99%

“…Data on the relationship between overall health status and quality of care are inconsistent. [34][35][36][37][38] Some studies show that individuals in poor health receive better technical care than healthier individuals; 35,36 others suggest that less healthy patients rate their doctors lower on interpersonal quality. 34,38 It is unknown whether patients with uncontrolled BP experience poorer communication with physicians.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

et al. 2009

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BACKGROUND: Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. OBJECTIVE:To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." DESIGN, SETTINGS, AND PATIENTS:Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. MEASUREMENTS:Communication behaviors and visit length from coding of audiotapes. RESULTS:After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B=−3.9 min, p<0.01) with less biomedical (B=−24.0, p=0.05), psychosocial (B=−19.4, p< 0.01), and rapport-building (B=−19.5, p=0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP.CONCLUSIONS: This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

et al. 2009

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“…No association for relational continuity. Fung, 2008 (23) Two approaches were used: 1. Count of individual conditions: the number of chronic conditions co-occurring in each participant was summed, without considering any concordance among the conditions.…”

Section: Quality Of Diabetes Care (Intermediate Outcomes)mentioning

confidence: 99%

Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review

Ricci‐Cabello

Violán

Foguet-Boreu

et al. 2015

European Journal of General Practice

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The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identifi ed 37 studies focussing on multi-morbidity but using conceptually diff erent approaches. Studies focusing on ' comorbidity ' (i.e. the ' index disease ' approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on ' multi-morbidity ' (i.e. multiplicity of problems) and ' morbidity burden ' (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.

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“…This finding highlights the importance of interprofessional communication because managing MSK in the context of both CV and multimorbidity 17,18 is likely to further complicate treatments and result in intensive healthcare services use, increasing the potential for communication failure and adverse outcomes.…”

Section: Rheumatologymentioning

confidence: 94%

“…Increasingly, people with MSK experience coexisting chronic health conditions (termed "multimorbidity"). In this context, effective communication is particularly important because multimorbidity affects quality of life 16 and contributes to adverse events and outcomes, and increases healthcare use 17,18 . Given these factors, a nationally representative population with MSK is a logical starting place to better understand the implications of CV.…”

mentioning

confidence: 99%

Communication Vulnerabilities in Working-age Australians with Musculoskeletal Conditions: A Cross-sectional Analysis

Lowe

Taylor²,

Hill³

2015

J Rheumatol

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Objective.To estimate the prevalence of communication vulnerability (CV) and its association with various health measures among working-age Australians with musculoskeletal conditions (MSK). The various vulnerability characteristics may lead to inadequate communication between consumers and healthcare professionals.Methods.Prevalence of CV among 18–64 year olds, with or without MSK, was analyzed using the Australian Bureau of Statistics’ National Health Survey 2007–08 data. Associations between CV and measures of health complexity (accumulating multimorbidity and risk factors) and health burden (poorer self-rated health, psychological distress, and pain restricting work) in the MSK population were estimated using logistic regression. Further analyses were conducted for each vulnerability characteristic to determine the degree of association (crude and adjusted) with measures of interest.Results.CV were more prevalent in working-age Australians with MSK (65%) than those without (51%). Adjusted for age and sex among working-age Australians with at least 1 MSK, those with 1 or more CV were more likely to have multimorbidity [adjusted OR (aOR) = 1.8, 95% CI 1.5–2.2], lifestyle risk factors (aOR = 2.1, 95% CI 1.5–2.8), poorer self-rated health (aOR = 3.4, 95% CI 2.7–4.2), greater psychological distress (aOR = 2.9, 95% CI 2.3–3.7), and pain restricting employment (aOR = 1.7, 95% CI 1.4–2.1) compared with those without CV.Conclusion.For working-age people, there is an association between MSK and CV. For those with MSK, CV were associated with increased likelihood of health complexity and burden. These findings have policy and clinical relevance. Research is needed to determine whether interventions that address these specific CV characteristics reduce the burden of disease within these populations.

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The Relationship Between Multimorbidity and Patients’ Ratings of Communication

Cited by 49 publications

References 30 publications

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication

Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review

Communication Vulnerabilities in Working-age Australians with Musculoskeletal Conditions: A Cross-sectional Analysis

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