Patient‐Provider Relationships in an All‐Inclusive Specialized Geriatric Program: A Longitudinal Qualitative Study among Older Foreign‐Born Latinos with Multimorbidities

Abstract

AbstractObjectiveThe quality of patient‐provider relationships (PPR) is directly related to delivering patient‐centered care and improved healthcare outcomes (e.g., adherence to medical treatments) and differs across types of patients to the point of health disparities. PPRs are further complicated when factoring in multiple chronic health conditions, language barriers, and limited time. This qualitative longitudinal study explored the perceived acquiring of high‐quality PPR among older foreign‐born Latinos over time.MethodsWe recruited 13 patients with multi‐morbidities from nine Program of All‐Inclusive Care for the Elderly (PACE) centers. Researchers conducted three rounds of in‐depth interviews in Spanish (N=39 interviews) over 13 months. The first interviews were conducted face‐to‐face and lasted one hour on average. The second and third were conducted over the phone and ranged from 60 to 90 minutes. Data were analyzed using line‐by‐line in vivo coding, identifying categories, and themes.ResultsPatients reported their perceived PPR as a continuum across time, establishing three hypothesized hierarchical developmental levels to the PPR: the good doctor, the doctor of trust, and the advocate. The layers of levels built upon each other. The first level, the good doctor, was the most superficial as it focused on the physicians' technical expertise. The second level, the doctor of trust demonstrated trustworthy characteristics over time. The third level, the advocate, embodied all that a person of trust was plus an additional advocacy dimension.ConclusionUnique study characteristics allowed for an exploration of PPRs. Findings elucidate factors (e.g., expertise, trust, advocacy) that contribute to the development of strong PPRs. To enhance PPRs, strategies should be considered to develop trust and advocate for patients' needs.