US Older Adults with Multiple Chronic Conditions Perceptions of Provider-Patient Communication: Trends and Racial Disparities from MEPS 2013-2019

Abstract

Background: Multiple chronic conditions (MCC) require complex patient-centered approaches with effective provider-patient communication.

Objective: To describe trends in patient perceptions of provider-patient communication during non-emergency care and identify associated racial disparities in US older adults with MCC.

Design, setting, participants: Observational study using pooled US Medical Expenditure Panel Survey (2013-2019) data included adults > 65 with two or more chronic conditions.

Main measures: Provider-patient communication was measured by four indicators (how often their doctor explained things clearly, listened carefully, showed respect, and spent enough time with them). The primary outcomes were the annual rates of reporting "always" for the communication indicators. Cochran-Armitage trend tests examined the trends of reporting "always" and associated racial disparities. Multivariable logistic regression identified racial and other factors associated with respondents choosing "always" for one or more categories for provider-patient communication, defined as positive communication.

Results: Among 9758 older adults with MCC, declining trends for positive communication were shown across all provider-patient communication categories during 2013 to 2019 (p<0.001). The greatest decrease occurred in "always listening carefully", from 68.6% in 2013 to 59.1% in 2019 (p<0.001). The declining trends of four communication measures in non-Hispanic Whites with MCC were significant (p<0.001). Older adults from Hispanic or Non-Hispanic Black racial backgrounds were 28 to 51% more likely to report "always" for the four indicators of provider-patient communication than non-Hispanic Whites after adjusting for respondents' characteristics.

Conclusion: The rates of "always" reporting positive communication with providers significantly declined from 2013 to 2019 in older adults with MCC, particularly in non-Hispanic Whites. Hispanics and non-Hispanic Blacks were more likely to report positive communication with providers than other races.

Keywords: multiple chronic conditions; provider-patient communication; racial disparity.

Figure 1

Study sample. Persons with a positive sampling weight were included in the full-year data and eligible to receive a self-administered questionnaire. MCC, multiple chronic conditions.

Figure 2

Trends of annual rates of reporting “always” for provider-patient communication measures in older adults with MCC vs. no MCC from 2013 to 2019 (n = 13,292). Errors bars represent 95% confidence intervals. MCC, multiple chronic conditions.

Figure 3

Overall rates of reporting “always” for provider-patient communication measures by race in older adults with multiple chronic conditions (n = 9758). Errors bars represent 95% confidence intervals.

Figure 4

Trends of racial disparities in annual rates of reporting “always” for provider-patient communication measures in older adults with multiple chronic conditions (2013–2019) (n = 9758). Errors bars represent 95% confidence intervals.