Patient Perceptions of Patient-Centered Medical Home Characteristics and Satisfaction with Free Clinic Services.

Abstract

The patient-centered medical home (PCMH) is a model of health care delivery designed to improve patient health outcomes by increasing the effectiveness of primary care. The effectiveness of PCMH on vulnerable populations is still largely unknown. The purpose of this study was to examine the relationship between patient perceptions of PCMH characteristics and patient satisfaction among Spanish-speaking and non-Spanish-speaking patients receiving health care at free clinics. A self-administered survey was used to collect data in 2 free clinics in the United States in 2013. Patients were primarily young and female; 44% were Spanish speaking. Patient perceptions of PCMH characteristics were assessed using multi-item Consumer Assessment of Healthcare Providers and Systems scales developed by the Agency for Healthcare Research and Quality. Patient satisfaction was assessed as satisfaction with care received at the clinic and willingness to recommend the provider. Multivariate logistic regression modeled the association between PCMH components and these 2 patient satisfaction measures. In adjusted analyses among Spanish speakers, satisfaction with clinic care was associated with staff helpfulness (OR = 6.03, 95% CI = 1.87-19.46) and no perceived discrimination (OR = 2.55, 95% CI = 1.22-5.33). For non-Spanish speakers, provider communication and politeness significantly increased odds of satisfaction with clinic services. Provider communication was strongly associated with patients' intention to recommend the provider to others for both Spanish speakers and non-Spanish speakers (OR = 4.83, 95% CI = 1.35-17.24; OR = 5.42, 95% CI = 1.54-19.09, respectively). Findings suggest that interpersonal characteristics of providers and clinic staff are critical to patient satisfaction among vulnerable populations served by free clinics. Future studies should examine PCMH components and clinical outcomes among this population.