Only about one in four low-income Californians say they have easily comprehensible information for health decision-making, and 71 percent say they would like more. That's just one of the findings from a new statewide survey looking at "opportunities and challenges" in reaching this underserved population.
The report is the latest in a series from the Blue Shield of California Foundation and provides "important insights for those working to reshape the system in California and for the rest of the country," foundation executive director Peter Long said at a briefing and panel discussion in Washington, D.C., on Wednesday.
When asked about their top source of health information, media sources (TV, internet, printed material) nudged out medical professionals, 39 percent to 38 percent. However, reliance on a medical provider for information goes up — by 22 percent — if the patient usually sees the same person.
From the report:
Patients are also more apt to reply on their provider for information when they feel someone at their healthcare facility knows them (the definition of connectedness), as well as when providers explain things clearly, invite questions and encourage patients to be involved in their own care.
"People often dismiss populations of lower income because they're different," said Dr. Kavita Patel, managing director of Delivery System Reform at the Brookings Institution, at the briefing on Wednesday. "This study illustrates that no matter what your income is, patient engagement matters."
The survey is based on phone interviews with 1,018 Californians ages 19-64 with household incomes less than 200 percent of the federal poverty level (or about $46,000 for a family of four).
The report found that people with the strongest connection to their providers speak English and have insurance — which points to the challenge ahead in a state as diverse as California, as the Affordable Care Act is fully implemented on Jan. 1.
Yet the report also pointed to steps providers and health centers can take to engage their patients. In particular, patients who perceive that their provider encourages them to be active in their own care and feel that they have as much say in their health decisions as they want are significantly more likely to feel a "strong rapport" with their provider. They also feel "very informed" about their health and trust the doctor's information, according to the report.
Sara Rosenbaum, professor of health policy at the George Washington University School of Public Health, pointed out that "it was no surprise to me that poor people should value good health care (as much as) anyone else does."
Though much has been written of the digital divide, this new report teased out information that surprised even the panel. Four in 10 low-income Californians lack Internet access, the survey found, but that number spikes to 67 percent of low-income Spanish speakers.
Dr. Ron Yee worked for 20 years at United Health Centers, a group of community clinics in the Central Valley. "I knew our patients did not have access to the Internet," he said at the briefing, "but I was surprised to see 67 percent of our Spanish speakers did not have access. That's a big number for us to understand."
Of the people in the survey who use the Internet, three-quarters are interested in access to a health center's Internet patient portal. Of the few who have access, "virtually all find it useful," the report found.
A similar disparity was found in email or text messages from providers. While very few low-income Californians have access to the technology, of those who do, 87 percent found email or text messages from the clinic or provider useful.
While California faces a shortage of primary care providers at the moment when access to insurance is expanding, alternative approaches can help with access and communication. For example, team-based care where a patient may see a nurse practitioner or physician assistant or health navigators — people who help patients make their way through a hospital or clinic — can "enhance, rather than diminish, the critical connection between patients and their providers," the report found.
"Patients are ahead of policymakers here," Peter Long noted, adding that critics had said that expanding access would lead to greater demands on physicians. But low-income Californians "are open to team care."
We've heard a lot about mandates," Patel observed. "This is the patient mandate. These folks were very clear about their aspirations. ... What they're willing to do if engaged to me is heartening."