Are Community HeaLth Centers Spaces For Patient-Centered Care? Using Intersectionality To Uncover The Quality Of Physician Care For Hispanic/Latinx Subgroups
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2019
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University of Hawaii at Manoa
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Community health centers are private non-profits, federally designed to provide quality and affordable healthcare for disadvantaged populations in the United States. Many of these community-based clinics have built into their mission statements, calls for patient-centered care: the practice of respecting a patients’ unique lived experiences. As Hispanic/Latinx are one of the largest groups served by this institution, and the largest minority group within the United States, it is vital that academic studies evaluate their quality of care. This paper addresses whether community health centers actively promote patient centered-care for Hispanic/Latinx female and SES subgroups. This paper is built upon a rich tradition of scholarship that has explored the quality of care using theories on patient-centered and paternalistic qualities of care within the United States healthcare system. While most of these works have used single-axis frameworks, more modern studies have incorporated theories of intersectionality. However, avenues of study remain largely unexplored. Only a few studies have been published on the role of community heath centers in promoting patient-centered care. Fewer have utilized data from the 2014 Health Center Survey- a comprehensive report on patient sociodemographic profiles, health outcomes, and quality of care. Despite this rich source, there has yet to be any published study on whether Hispanic/Latinx patients, across a wide spectrum of intersecting statuses, have reported patient-centered care at these clinics. Ordered logistic regression was used to determine the quality of doctor-patient interaction for Hispanic/Latinx groups (n=882) by gender, nativity, language, and socioeconomic statuses. Alpha and factor analysis was employed to aggregate the following measures into a single-12-point doctor-patient interaction scale that is used as the dependent variable: whether the doctor listened carefully to them, showed respect for patient input, provided easy-to-understand information, and spent adequate time with the client. Hispanic/Latinx across all categories reported positive doctor-patient interaction, compared to all other racial groups (n=2,042). The categories of female (p=.435), poor (p=.401), in poverty (p=.401), and unemployed (p=.611) showed no significant correlation. Hispanic/non-English speaking (p=.000**) and Hispanic/foreign-born (p=.000**) subgroups reported better quality of care. While these findings show that being Hispanic/Latinx, as well as the intersecting categories of non-English speaking and foreign-born are associated with positive doctor-patient interaction, future studies should be done to determine the underlying patterns behind these findings. In addition, it is vital that such studies continue to utilize both doctor-patient interaction and intersectionality theories. Further policies aimed at promoting patient-centered care at community health centers must also take into consideration the effects of multiple forms of adversity across all racial/ethnic categories.
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