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Patient-Centered Care Lacking for Minorities, Low-Income Patients

Data shows that the quality of patient-centered care is heavily dependent upon race, insurance, and income level, resulting in disparities for Black, Hispanic, and low-income patients.

There is a growing racial and economic divide in the receipt of patient-centered care, with minority and low-income patients having their care preferences taken into account less frequently than White patients, a study by the LeadingAge LTSS Center @UMass Boston and the Center for Consumer Engagement in Health Innovation at Community Catalyst has found.

Patient-centered care improves the patient experience by taking into account patient preferences, goals, values, and needs. Ultimately, patient-centered care helps better diagnose patients and treat illnesses.

However, a lack of patient-centered care can lead to worse health outcomes, higher healthcare costs, and less preventive care, study researchers found.

“Race, income, and insurance status play a huge role in whether a person’s wishes are heard, and our research shows that when they are not, outcomes can be negative,” Marc Cohen, PhD, an author of the report, said in the study. “The data provide a critical benchmark for the state of patient-centered care before the pandemic. In coming months we will be able to see the impact of the first year of COVID on patient-centered care.” 

The study, funded by The SCAN Foundation, examined trends in patient-centered care using data from 2014, 2016, and 2018.

Overall, one-third of older patients stated that their care preferences were either never or only sometimes taken into account. Moreover, patients who fell into different demographic groups had public insurance coverage, or were low-income were more likely to say their care never or rarely accounts for their preferences.

Nearly one in four Hispanic patients reported never having their preferences considered during a healthcare visit. This compares to 7 percent of White patients and almost 17 percent of Non-Hispanic Black patients who said the same.

These racial disparities in care preference ratings will only widen over time, the researchers stated.

The number of Black and Hispanic patients reporting that their care preferences are never considered increased during the course of the study; meanwhile, these rates decreased for White patients.

These disparities remain true for patients living under the federal poverty level. Patients who reported ever having their preferences taken into account were twice as likely to live below the federal poverty level compared to those who state that clinicians always consider their preferences.

In terms of health insurance, many Medicaid patients reported clinicians sometimes or never consider their care preferences.

Researchers noticed that by having a usual source of care, such as a primary care provider, the likelihood of receiving patient-centered care increases, mitigating some of the deep racial and economic inequities found.

“Rebuilding primary care needs to be a key priority to enable individuals of all races, socioeconomic backgrounds, and medical plans the ability to receive quality care,” said Sarita Mohanty, MD, president, and CEO of The SCAN Foundation. “Providers and policymakers have an opportunity to advance person-centered care to strengthen a patient’s connection to a primary care provider.”

“This helps ensure healthcare needs are met and can reduce the deep racial and economic inequities that exist in healthcare. We need action, and we need it now,” Mohanty added. “All of this starts with actually listening to what patients want.”

To remedy the disparities in patient-centered care, researcher urge policymakers to improve reimbursement and outcomes measurement and expand access to primary care.

Separate studies have found that access to primary care is seriously lacking. US adults are among the least likely to have a regular doctor to access care compared to other developed nations, with 89 percent of adults reporting as much, according to the Commonwealth Fund.

Moreover, most US patients don’t have a longstanding relationship with their doctors, which could contribute to the lack of patient-centered care.

Relationships with providers are essential, as healthcare is personal and requires a supportive as well as trusting patient-provider relationship.

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