Does Patient-Centered Communication by Physicians Facilitate Cardiometabolic Disease Self-management Among Community Health Center Patients? A Nationwide Study.

BACKGROUND

Cardiometabolic self-management through lifestyle behavior change is critical for patients with cardiometabolic risk conditions (obesity, high blood pressure, type 2 diabetes (T2DM) and/or dyslipidemia) to avoid life-threatening complications.

OBJECTIVE

To examine whether patient-centered communication (PCC) by community health center (CHC) physicians may facilitate patients with cardiometabolic conditions to implement disease self-management behaviors in daily life.

RESEARCH

DESIGN

We used secondary data from the 2022 Health Services and Resources Administration-Research Triangle International-designed, nationally representative sample survey of CHC patients (response rate 85.0%). We assessed the association of patients' adoption of cardiometabolic self-management behaviors in five domains (weight management, dietary change, physical activity, reducing sedentariness, and smoking reduction) with ratings of their physician's PCC during primary care visits.

PARTICIPANTS

2,942 adults aged 18-74 years, with cardiometabolic condition(s) completing a primary care visit.

MEASURES: Outcome: Cardiometabolic self-management (SM) score, sum of patient's weighted fraction scores of behaviors in five domains, multiplied by 100 to obtain a whole integer-based, ratio-scale score. Key independent variable: Patient-rated physician PCC aggregated from scores on five adapted Consumer Assessment of Healthcare Providers and Systems survey questions (CAHPS) during primary care visits (Likert scale 0-3).

RESULTS

Among 2,942 study-eligible patients (25.3% with T2DM, 62.8% obesity, 60.1% hypertension, 50.9% dyslipidemia), the mean cardiometabolic SM score was 246.3 (±82, median 250, possible score range, -30 to 470). The mean PCC score (validated by exploratory factor analysis) was 17.7 (±3.3, median 20, possible range 0-20). A unit increase in PCC was associated with 1.8-point increase in patients' SM score (SE 0.5, p<0.001), after adjusting for demographic variables, chronic conditions, and patient-reported measures of their enabling environment for physical activity, food security, and physical/mental health disability.

CONCLUSIONS

Physicians' PCC as measured by the CAHPS survey may promote better self-management of cardiometabolic conditions by CHC patients who often have low health literacy.