Primary care can build patient trust, reduce racial, economic inequities

Race, insurance and income levels all affected how health care providers consider patient preferences of older adults, according to a new study.

However, trusting relationships between patients and primary care providers help ensure patient preferences are taken into account, mitigating racial and economic inequities.

“Person-centered care” in medicine aims to take the whole person into account and aims to address individuals’ preferences, needs, and values, according to the Center for Consumer Engagement in Health Innovation (CCEHI).

Not all patients felt health care providers achieved that from 2014 to 2018, according to the CCEHI study “Person-Centered Care: Why Taking Individuals’ Care Preferences into Account Matters.”

Among the 2018 respondents, 24% of Hispanic adults report never having their preferences considered, compared to 17% for Black and 7% for white older adults.

The figures for Hispanic and Black adults both were up from 2014 and 2016 levels, according to a news release and the study from CCEHI.

“Our results confirm a disturbing, persistent and growing racial and economic divide in receipt of person-centered care, with minorities and low-income individuals being twice as likely to report that their care preferences are never considered,” the report said. “These disparities appear to be worsening over time, with more minorities reporting that their care preferences are never considered, even as these rates are decreasing for nonminority populations.”

Results were based on the analysis of data from about 20,000 participants, age 50 and older, in the Health and Retirement Study conducted by the University of Michigan.

The survey examined factors including income, insurance status, health care utilization, biomarkers such as blood sugar, cholesterol levels, hypertension and waist circumference, and preventive care.

The findings “reinforce the importance and urgency of ensuring that older adults’ care preferences are considered,” the report said.

Consideration of patient preferences is a key link to outcomes such as avoiding unnecessary emergency care, controlling diabetes or blood pressure, and encouraging vaccinations and preventive care, CCEHI said.

CCEHI also called for rebuilding primary care for providers who can build trusting relationships with patients who benefit from having a usual source of medical care.

Having a usual source of care “increases the likelihood that one’s preferences are taken into account, and can mitigate some of the deep racial and economic inequities found in who receives person-centered care.”

The analysis was completed with the LeadingAge LTSS Center @UMASS Boston with support from the SCAN Foundation.