Miriam Komaromy1, Erin Fanning Madden2, Andrea Zurawski3, Summers Kalishman4, Kristin Barker5, Patricia O'Sullivan6, Martin Jurado3, Sanjeev Arora7. 1. The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. Electronic address: Miriamk1@salud.unm.edu. 2. Department of Sociology, University of Texas, San Antonio, TX, USA. 3. The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA. 4. The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Family and Community Medicine, Office of Education at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA. 5. Department of Sociology, University of New Mexico, Albuquerque, NM, USA. 6. The University of California, San Francisco CA, USA. 7. The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Abstract
OBJECTIVE: Elicit patients' perceptions of factors that facilitate their engagement in care METHODS: In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs. RESULTS: Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors. CONCLUSION: These findings illuminate factors promoting "contingent engagement" for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes. PRACTICE IMPLICATIONS: For these patients, engagement is contingent on healthcare providers' efforts to develop trust and address patients' material needs.
OBJECTIVE: Elicit patients' perceptions of factors that facilitate their engagement in care METHODS: In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs. RESULTS: Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors. CONCLUSION: These findings illuminate factors promoting "contingent engagement" for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes. PRACTICE IMPLICATIONS: For these patients, engagement is contingent on healthcare providers' efforts to develop trust and address patients' material needs.
Authors: Margae Knox; Emily E Esteban; Elizabeth A Hernandez; Mark D Fleming; Nadia Safaeinilli; Amanda L Brewster Journal: BMJ Open Qual Date: 2022-06
Authors: Miriam Komaromy; Judy Bartlett; Sarah R Gonzales-van Horn; Andrea Zurawski; Summers G Kalishman; Yiliang Zhu; Herbert T Davis; Venice Ceballos; Xi Sun; Martin Jurado; Kimberly Page; Allison Hamblin; Sanjeev Arora Journal: J Gen Intern Med Date: 2019-10-30 Impact factor: 5.128