– The current primary care model isn’t fitting the needs of low-income or vulnerable patient populations, with most calling for a more personal, patient-centered experience, according to a series of focus groups conducted by the Center for Consumer Engagement in Health Innovation.
The nine focus groups included individuals with complex social and medical needs, ranging from elderly adults to those who were unemployed and experiencing homelessness. Participants hailed from Georgia, Colorado, California, and Pennsylvania.
“This report first and foremost underscores that our primary care system is not well organized around what consumers who are low-income say they need and want,” Ann Hwang, MD, the director of the Center and a primary care provider herself, said in a statement.
“The system, with hurried visits, large caseloads and high levels of paperwork, frustrates clinicians, as well, complicating the ability to deliver high quality, whole-person care. The good news is that despite their cynicism and mistrust, consumers are very clear about what a better primary care system could and should look like. They remain hopeful, and their ideas are sweeping and could fundamentally restructure how primary care is delivered.”
Specifically, the researchers looked at patients experiencing a number of social determinants of health, with most reporting financial stress, limited access to transportation, food access challenges, and housing insecurity. Respondents also reported challenges with substance use disorder, mental and behavioral health, social isolation, and family separation.
These patients are being failed by the traditional primary care system, the focus groups revealed, with most participants agreeing that the system is too financially driven. Profit margins at least appear to take priority over conducting person-centered visits. Overwhelmingly, patients perceived the primary care industry as working to churn out numerous patient visits in a day, rather than holistic and meaningful patient visits.
Patient relationships with their primary care clinicians are also struggling. Although patients were able to identify a primary care provider they feel comfortable seeing, very few reported meaningful interactions with their primary care providers.
For example, communication about the social determinants of health and other social factors impacting patient health were few and far between, the focus groups revealed. This comes even as the focus group, and several other separate assessments, suggest patients would welcome discussions about the social determinants of health.
Overall, focus group participants offered five recommendations to make the primary care system work better for them.
First, patients said the opportunity to develop long-term relationships with a primary care provider would be beneficial to improving their health. Strong patient-provider relationships make it easier for providers to put a patient’s medical conditions into the context of their lives and their medical histories, while also making it easier for patients to trust their providers and open up.
Second, patients expressed interest in a patient navigator or social worker who could help them manage their medical and social needs. The healthcare industry is complex, the focus group participants said, but a case worker could help them navigate the numerous medical-related institutions they need to access. On the provider side, case workers and care navigators could help drive care coordination and ensure patient adherence to care and social services plans.
Third, and as noted above, focus group participants were interested in having discussions with their providers that go beyond the scope of traditional medical care. Conversations about the social determinants of health need to be done in an empathic and compassionate way, with providers offering concrete solutions to patient issues, experts suggest.
Fourth, patients were receptive to more healthcare integration, or the idea that they could receive medical, mental, and behavioral healthcare all under one roof. Separate studies suggest primary care and mental healthcare integration improves health outcomes.
Finally, patients are looking for a primary care provider who can deliver culturally competent care. Providers who are sensitive to unique cultural needs or norms, who can relate to or be sensitive to a patient’s lived experiences, and who use language that is understandable for patients will drive patient experiences.
While this report outlined much work ahead in primary care, the authors asserted that there is a hopeful conclusion. Focus group participants did not appear to be disconnected from the medical industry, meaning it is still possible to drive population health efforts.
“Marginalized consumers, facing many barriers and often complex needs, are not being well-served by the present system,” the researchers concluded. “Despite significant cynicism and frustrations with the system they see today, consumers have hope. This research indicates they are eager to help us think about how to get from where we are today to the new system they imagine.”