Article

Satisfaction With Provider Communication Among Spanish-Speaking Medicaid Enrollees

Portland State University, Portland, Oregon, United States
Ambulatory Pediatrics (Impact Factor: 2.49). 11/2004; 4(6):500-4. DOI: 10.1367/A04-019R1.1
Source: PubMed

ABSTRACT

To determine if differences between English- and Spanish-speaking parents in ratings of their children's health care can be explained by need for interpretive services.
Using the Consumer Assessment of Health Plans Survey-Child-Survey (CAHPS), reports about provider communication were compared among 3 groups of parents enrolled in a Medicaid managed care health plan: 1) English speakers, 2) Spanish speakers with no self-reported need for interpretive services, and 3) Spanish speakers with self-reported need for interpretive services. Parents were asked to report how well their providers 1) listened carefully to what was being said, 2) explained things in a way that could be understood, 3) respected their comments and concerns, and 4) spent enough time during medical encounters. Multivariate logistic regression was used to compare the ratings of each of the 3 groups while controlling for child's gender, parent's gender, parent's educational attainment, child's health status, and survey year.
Spanish-speaking parents in need of interpretive services were less likely to report that providers spent enough time with their children (odds ratio = 0.34, 95% confidence interval = 0.17-0.68) compared to English-speaking parents. There was no statistically significant difference found between Spanish-speaking parents with no need of interpretive services and English-speaking parents.
Among Spanish- versus English-speaking parents, differences in ratings of whether providers spent enough time with children during medical encounters appear to be explained, in part, by need for interpretive services. No other differences in ratings of provider communication were found.

Download full-text

Full-text

Available from: Leo S. Morales, Jul 17, 2014
  • Source
    • "Responses to items 2 and 3 were categorized on an ordinal scale of " never, " " sometimes, " " usually, " or " always. " The data were highly skewed, so consistent with the literature, responses were dichotomized to " always " and " not always " (Mosen et al., 2004; Saha et al., 2003; Wallace et al., 2007). Items 1 and 4 were dichotomous questions with yes/no responses. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use. A hurdle model was employed using data from the 2007 to 2009 Medical Expenditure Panel Survey. First, a multivariate logistic regression model was used to identify factors associated with the likelihood of a nonemergent ED visit. Given that one occurrence exists, a second negative binomial model was used to establish whether patient-provider communication or access are related to the frequency of nonemergent ED use. One element of communication, patient-provider language concordance, is associated with fewer nonemergent ED visits (P < .05). Several aspects of access are related to reduced ED use for nonemergent purposes. Patients whose USC is available after hours and those who travel less than an hour to get to their USC use the ED less for nonemergent care (P ≤ .05). Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services.
    Full-text · Article · Nov 2013 · The Journal of the American Board of Family Medicine
  • Source
    • "Responses to items 2 and 3 were categorized on an ordinal scale of " never, " " sometimes, " " usually, " or " always. " The data were highly skewed, so consistent with the literature, responses were dichotomized to " always " and " not always " (Mosen et al., 2004; Saha et al., 2003; Wallace et al., 2007). Items 1 and 4 were dichotomous questions with yes/no responses. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the association between how patients rate their health care provider's communication and the receipt of six clinical preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP). This study used national data from the 2009 Medical Expenditure Panel Survey (MEPS). The samples (sizes vary by service) included individuals aged 18years and older who have a usual source of care (USC). The outcomes indicated whether or not individuals received screening for breast cancer, cervical cancer, colon cancer, high cholesterol, hypertension, or were vaccinated against influenza per clinical guidelines. Multivariate logistic regression models were created for each dependent variable. The main independent variables consisted of ratings of four patient-provider communication behaviors. In unadjusted analyses, respondents who rated their providers' communication higher reported greater utilization of preventive services. After controlling for confounding variables, only receipt of mammograms remained significantly associated with better communication (p<0.05). Screening for cervical cancer, colon cancer, high cholesterol, and influenza vaccination approached significance with better communication (p<0.10). Patient-provider communication is associated with receipt of regular mammograms. Clinicians should consider their medical dialogue with patients as a stimulus for appropriate screenings and vaccinations.
    Full-text · Article · Sep 2013 · Preventive Medicine
  • Source
    • "For this study, an a priori decision was made to not profile or rank individual study sites, but rather to focus on patient reports of care with respect to communication and satisfaction with care. We used studies in the literature to guide our selection of covariates and model factors that influence provider communication and patient satisfaction with care12,17,22,23,25. Using the imputed dataset, we conducted three multiple variable linear regression models to estimate the impact of interpreters on our three outcome measures while adjusting for survey year and clustering26 at the site of care [intraclass correlation coefficient (ICC) =0.020–0.026]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Hablamos Juntos-Together We Speak (HJ)--national demonstration project targeted the improvement of language access for Spanish-speaking Latinos in areas with rapidly growing Latino populations. The objective of HJ was to improve doctor-patient communication by increasing access to and quality of interpreter services for Spanish-speaking patients. To investigate how access to interpreters for adult Spanish-speaking Latinos is associated with ratings of doctor/office staff communication and satisfaction with care. Cross-sectional cohort study. A total of 1,590 Spanish-speaking Latino adults from eight sites across the United States who participated in the outpatient HJ evaluation. We analyzed two multi-item measures of doctor communication (4 items) and office staff helpfulness (2 items), and one global item of satisfaction with care by interpreter use. We performed regression analyses to control for patient sociodemographic characteristics, survey year, and clustering at the site of care. Ninety-five percent of participants were born outside the US, 81% were females, and survey response rates ranged from 45% to 85% across sites. In this cohort of Spanish-speaking patients, those who needed and always used interpreters reported better experiences with care than their counterparts who needed but had interpreters unavailable. Patients who always used an interpreter had better adjusted ratings of doctor communication [effect size (ES = 0.51)], office staff helpfulness (ES = 0.37), and satisfaction with care (ES = 0.37) than patients who needed but did not always use an interpreter. Patients who needed and always used interpreters also reported better experiences with care in all three domains measured [doctor communication (ES = 0.30), office staff helpfulness (ES = 0.21), and satisfaction with care (ES = 0.23)] than patients who did not need interpreters. Among adult Spanish-speaking Latinos, interpreter use is independently associated with higher satisfaction with doctor communication, office staff helpfulness, and ambulatory care. Increased attention to the need for effective interpreter services is warranted in areas with rapidly growing Spanish-speaking populations.
    Full-text · Article · Dec 2010 · Journal of General Internal Medicine
Show more