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Patient-centered primary care and self-rated health in 6 Latin American and Caribbean countries: Analysis of a …

1 and 2 present the characteristics of study participants from 6 LAC countries (n = 6,100) double-weighted by survey and stabilized IP weights. Slightly more women than men participated in all countries (52.2% versus 47.8% in the full sample). Participants reported lower education levels in Brazil, Panama, and El Salvador (62.7%, 37.5%, and 33.4% with elementary school or less, respectively), while approximately half the sample had completed secondary school in Mexico, Colombia, and Jamaica. Government HI predominated in Brazil and Jamaica (76.5% and 61.5%, respectively), while social security HI was more common in Colombia, Panama, Mexico, and El Salvador (65.1%, 62.4%, 48.9%, and 47.4%, respectively). The proportion with private HI ranged from 9.8% in Colombia and El Salvador to 38.5% in Jamaica. Report prevalence of chronic conditions ranged from 31.5% in El Salvador to 52.2% in Jamaica. Finally, the percentage of participants with excellent or very good SRH was highest in Jamaica (52.4%), declining to a low of 29.5% in Mexico.


https://doi.org/10.1371/journal.pmed.1002673.t001


https://doi.org/10.1371/journal.pmed.1002673.t002

3 and 4 show the participants’ experience with PC services in the full sample and by country. The proportion of participants who reported that the PC facility was easy to contact by telephone during regular office hours ranged from 38.1% in El Salvador to 75.2% in Jamaica. Patients from Brazil reported less frequently that the PC provider spent enough time with them (31.8%), while in Colombia this figure reached 74.2%. Regarding patient–provider communication, the opportunity to ask questions and having the PC provider explain things in a way that was easy to understand were less frequent in Brazil (58.0% and 63.9%, respectively) and more frequent in Mexico (79.5% had the opportunity to ask questions) and Colombia (81.3% received explanations in a way that was easy to understand). Relating to the technical quality of care, only 40.9% in Brazil reported that the PC provider knew relevant information about their medical history, while this figure was 75.4% in Mexico. Only between 25.9% (in Jamaica) and 44.2% (in Panama) reported that the PC provider talked about healthy lifestyles, while between 25.8% and 26% (in Panama and El Salvador) and 40.7% and 40.2% (in Brazil and Mexico) had their preventive exams up to date. The percentage of participants who considered that the PC provider solved most of their health problems ranged from 54.2% in Brazil to 80.6% in Mexico, while only from 21.8% (in Brazil) to 45.4% (in Mexico) stated that the PC provider helped to coordinate healthcare. The average OPCE score ranged from 0.44 points in Brazil to 0.63 points in Mexico.


https://doi.org/10.1371/journal.pmed.1002673.t003


https://doi.org/10.1371/journal.pmed.1002673.t004

In bivariable analyses, the average OPCE score was significantly higher in participants with excellent or very good SRH in 4 out of 6 countries. For specific features of patient-centered PC, the proportion of respondents with excellent or very good SRH was significantly higher among those who had a PC facility that was easy to contact in Colombia, El Salvador, and Mexico; who reported that the PC provider spent enough time with them in Colombia and Mexico; who had the opportunity to ask questions in Brazil, Colombia, and Mexico; who had a PC provider who explained things in a way that was easy to understand in Brazil, Colombia, Jamaica, and Mexico; who perceived that the PC provider knew relevant information about their medical history in Colombia, Jamaica, and Mexico; who considered that PC provider solved most of their health problems in Brazil, Colombia, Jamaica, and Mexico; and who reported that PC provider coordinated care with other providers or sources of care in Colombia, El Salvador, Jamaica, and Mexico.

Table 5 shows the results of the pooled multiple Poisson regression model double-weighted by survey and stabilized IP weights to test the association of OPCE score with excellent or very good SRH. The coefficients represent prevalence ratios of the report of excellent or very good SRH; their interpretation is the same as for risk ratios. Assessment of interaction between countries and OPCE score identified a significant positive interaction in Mexico (RERI 0.55, 95% CI 0.09–1.02, p = 0.019) (S2 Table); we included an interaction term in the analytic model (Table 5). After adjustment for socio-demographic and health covariates, in all countries except Mexico, patients with an OPCE score of 1 were 1.6 times (95% CI 1.37–1.90, p 0.001) as likely to report excellent or very good SRH as those with a score of 0. The association was significantly stronger in Mexico: incorporating the interaction term, patients with an OPCE score of 1 had a 4.27 (95% CI 2.34–7.81, p 0.001) times higher probability of reporting excellent or very good SRH compared to those with an OPCE score of 0.


https://doi.org/10.1371/journal.pmed.1002673.t005

6 and 7 depict the association of specific PC patient experiences with excellent or very good SRH. We found evidence of multiple interactions between countries and specific features of patient-centered PC (S2 Table); we thus present results stratified by country (Tables 6 and 7). The analysis revealed differences among countries in patient experiences associated with a high probability of having excellent or very good SRH, when controlling for the study covariates. After adjustment for socio-demographic and health characteristics, the experience of easy contact with the PC facility by telephone during regular office hours was associated with excellent or very good SRH in Mexico (aPR 1.35, 95% CI 1.04–1.74, p = 0.023), the perception that the PC provider gives an opportunity to ask questions was associated with excellent or very good SRH in Brazil (aPR 1.42, 95% CI 1.11–1.83, p = 0.006), having a PC provider who knows relevant information about the patient’s medical history was associated with excellent or very good SRH in Mexico (aPR 1.47, 95% CI 1.03–2.12, p = 0.036) but was negatively associated with excellent or very good SRH in Brazil (aPR 0.71, 95% CI 0.56–0.89, p = 0.003), the perception that the PC provider solves most of the patient’s health problems was associated with excellent or very good SRH in Colombia (aPR 1.38, 95% CI 1.01–1.91, p = 0.046) and in Jamaica (aPR 1.21, 95% CI 1.02–1.43, p = 0.030), and coordination of care by the PC provider was associated with excellent or very good SRH in Mexico (aPR 1.53, 95% CI 1.19–1.98, p = 0.001). After adjustment for covariates, no individual features of patient-centered PC were associated with excellent or very good SRH in El Salvador or Panama.


https://doi.org/10.1371/journal.pmed.1002673.t006

https://doi.org/10.1371/journal.pmed.1002673.t007

Article source: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002673

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