QuickTake: How Often Do Patients Discuss Sensitive Issues with Their Providers?

 

Lea Bart and Sharon K. Long

September 15, 2017

 

Patient-centered models of health care, such as shared decisionmaking and medical homes, encourage patients to talk to their providers about issues that may affect their care, from treatment plans and costs to the day-to-day challenges that make maintaining health difficult.1 Existing surveys ask respondents whether they talked with their provider about health questions or concerns, but provide limited detail and cannot classify responses by key respondent characteristics. In this QuickTake, we use data from the September 2016 Health Reform Monitoring Survey (HRMS)2 to explore how often patients have conversations with their providers about the following potentially sensitive issues:

 

  1. health and health care challenges: whether there are things that make it hard to take care of their health or whether they have concerns about the health care they receive or their treatment plan
  2. concerns about cost of care: whether they have concerns about the cost of their health care
  3. life challenges and stresses: whether there are things in their life that cause worry or stress or whether they have problems in their day-to-day life or living situation

 

Survey respondents were asked whether they had spoken to the doctor or other health care provider they see most often for their health care about sensitive issues within the last 12 months.3 The survey questions build on questions in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.4 We limit the analysis to adults who saw their usual provider at some point in the last 12 months.5 The sample size for the analysis is 2,107 nonelderly adults. We examine how often adults reported discussing potentially sensitive topics with their providers overall and across population subgroups based on family income and the presence of health problems. Conversations about sensitive issues may be particularly important for patients with lower incomes and for those with a chronic condition or disability.

 

 

More than half of the nonelderly adults in the sample (55.3 percent) reported discussing at least one potentially sensitive issue with their usual provider in the last year (figure 1). Conversations about life challenges and stresses (42.8 percent) and problems or concerns about their health and health care (36.3 percent) were most common. Fewer than one in five adults reported a conversation with their provider about concerns about the cost of health care. Although we don’t have information on whether the adults would have liked to talk to their providers about the cost of care, 21.0 percent of the adults in the sample who did not report a conversation about cost reported going without needed health care because they could not afford it over the past year. This includes 9.4 percent who reported unmet need for doctor care and 10.7 percent who reported unmet need for medical tests, treatment, or follow-up care (data not shown).

 

 

Conversations about potentially sensitive topics were more common among low-income adults and adults with health problems. Almost two-thirds (64.2 percent) of adults with incomes at or below 138 percent of the federal poverty level (FPL) reported a conversation with their provider about at least one potentially sensitive issue, compared with less than half (46.4 percent) of adults with incomes at or above 400 percent of FPL (figure 2). Similarly, almost two-thirds (63.3 percent) of adults with a chronic condition or disability reported a conversation about at least one sensitive issue, compared with less than half (43.6 percent) of adults without such health problems (figure 3). Low-income adults and adults with health problems were more likely than their counterparts to report conversations on each of the three issues, although conversations were still relatively uncommon. Of the three-quarters of low-income adults in the sample who did not report a conversation with their provider about cost concerns, 33.4 percent reported unmet need for health care because they could not afford it, including 16.6 percent with unmet need for doctor care (data not shown). Among adults with a chronic condition or disability who did not report a conversation with their provider about cost concerns, 22.0 percent had an unmet need for health care because they couldn’t afford it and 8.9 percent had an unmet need for doctor care (data not shown).

 

 

Patient-centered care emphasizes increased patient-provider dialogue about sensitive issues, and many adults report such conversations with their providers. But our results show that some potentially beneficial conversations are not taking place; many adults who forgo needed health care (including doctor care and medical tests, treatment, or follow-up care) because they cannot afford it are not talking to their providers about the cost of care. These findings highlight the need for better patient-provider communication, especially among vulnerable populations.

 

References

 

AHRQ (Agency for Healthcare Research and Quality). 2015. About the Patient-Centered Medical Home Item Set 3.0. Rockville, MD: AHRQ.

 

Epstein, Ronald M., Kevin Fiscella, Cara S. Lesser, and Kurt C. Stange. 2010. “Why the Nation Needs a Policy Push on Patient-Centered Health Care.” Health Affairs 29 (8): 1489–95. doi:10.1377/hlthaff.2009.0888.

 

Levinson, Wendy, Cara S. Lesser, and Ronald M. Epstein. 2010. “Developing Physician Communication Skills for Patient-Centered Care.” Health Affairs 29 (7): 1310–18.

 

Long, Sharon K., and Lea Bart. 2017. “Patients Feel Comfortable Talking to Their Providers about Sensitive Issues, but Providers Don’t Often Ask.” Washington, DC: Urban Institute.

 

 

About the Series

 

This QuickTake is part of a series drawing on the HRMS, a survey of the nonelderly population that explores the value of cutting-edge Internet-based survey methods to monitor the ACA before data from federal government surveys are available. Funding for the core HRMS is provided by the Robert Wood Johnson Foundation and the Urban Institute.

 

For more information on the HRMS and for other QuickTakes in this series, visit www.urban.org/hrms.

 

About the Authors

 

Lea Bart is a research assistant and Sharon K. Long a senior fellow with the Urban Institute’s Health Policy Center.

 

Notes


1 James Rickert, “Patient-Centered Care: What It Means and How to Get There,” Health Affairs Blog, January 24, 2012. See also Levinson, Lesser, and Epstein (2010) and Epstein and colleagues (2010). ^

 

2 The data collection period for the September 2016 round of the HRMS extended into October and November for a small share of the sample. ^

 

3 This question was one of a group of three questions posed to random subsets of the HRMS sample. The other questions—whether providers had asked about potentially sensitive issues and whether patients would be comfortable discussing potentially sensitive issues with their provider—are analyzed in Long and Bart (2017). ^

 

4 These questions build on the following questions in the CAHPS patient-centered medical home item set: “In the last 6 months, did someone from this provider’s office ask you if there are things that make it hard for you to take care of your health?” and “In the last 6 months, did you and someone from this provider’s office talk about things in your life that worry you or cause you stress?” (AHRQ 2015). ^

 

5 Twenty-four respondents (about 1 percent of the sample) did not respond to the question; they are excluded from the analysis. ^

Urban Institute Robert Wood Johnson Foundation