Effect of Difficulty Affording Health Care on Health Status After Coronary Revascularization

Spertus, John A.; Decker, Carole; Woodman, Catherine; House, John A.; Jones, Phil; O'keefe, J. C.; Borkon, A. Michael

doi:10.1161/circulationaha.104.474775

Cited by 25 publications

(29 citation statements)

References 23 publications

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“…In CABG patients, those who experienced difficulties affording care reported a worse health status on undergoing CABG and 6 months after the procedure. 108 These results were replicated in 2 cohorts of outpatients with heart failure. Difficulties in obtaining affordable health care were associated with worse health status at baseline and at 1-year follow-up compared with those who did not report such difficulties, 109 and the perception about whether patients' income met their demands was independently associated with lower health status scores in another cohort of outpatients with heart failure.…”

Section: Health Status and Race/ethnicity And Socioeconomic Statusmentioning

confidence: 79%

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Rumsfeld¹,

Alexander²,

Goff³

et al. 2013

Circulation

472

406

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Section: Health Status and Race/ethnicity And Socioeconomic Statusmentioning

confidence: 79%

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Rumsfeld¹,

Alexander²,

Goff³

et al. 2013

Circulation

472

406

View full text Add to dashboard Cite

Section: S O Cioecono Mic S Tat Us a Nd C L Inic A L Decisionsmentioning

confidence: 99%

“…Some authors have suggested provocative ways that SES might be appropriately incorporated into treatment decisions, including consideration of education level as a risk factor for cardiovascular disease and accounting for education when prescribing preventive medications, or changing cardiac intervention decisions based on patients' ability to afford medications. 36,37 How such changes ultimately infl uence patient outcomes needs further investigation.Our interviews exposed the personal and fi nancial strains that physicians experience when caring for populations of patients of low SES. Many of the physicians no longer accept Medicaid patients, a phenomenon recently documented on a national level 38 ; they frequently spoke of burnout by those who provide care to patients of low SES in the current health care environment; and they fear the impact of payment linked to performance measurement on their practice.…”

mentioning

confidence: 99%

Influence of Patients' Socioeconomic Status on Clinical Management Decisions: A Qualitative Study

Bernheim

Ross²,

Krumholz³

et al. 2008

The Annals of Family Medicine

169

128

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PURPOSE Little is known about how patients' socioeconomic status (SES) infl uences physicians' clinical management decisions, although this information may have important implications for understanding inequities in health care quality. We investigated physician perspectives on how patients' SES infl uences care. METHODSThe study consisted of in-depth semistructured interviews with primary care physicians in Connecticut. Investigators coded interviews line by line and refi ned the coding structure and interview guide based on successive interviews. Recurrent themes emerged through iterative analysis of codes and tagged quotations. RESULTSWe interviewed 18 physicians from varied practice settings, 6 female, 9 from minority racial backgrounds, and 3 of Hispanic ethnicity. Four themes emerged from our interviews: (1) physicians held confl icting views about the effect of patient SES on clinical management, (2) physicians believed that changes in clinical management based on the patient's SES were made in the patient's interest, (3) physicians varied in the degree to which they thought changes in clinical management infl uenced patient outcomes, and (4) physicians faced personal and fi nancial strains when caring for patients of low SES.CONCLUSIONS Physicians indicated that patient SES did affect their clinical management decisions. As a result, physicians commonly undertook changes to their management plan in an effort to enhance patient outcomes, but they experienced numerous strains when trying to balance what they believed was feasible for the patient with what they perceived as established standards of care. Ann Fam Med 2008;6:53-59. DOI: 10.1370/afm.749. INTRODUCTIONS ocioeconomic status (SES) infl uences health care quality and outcomes. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Patients of low SES receive fewer preventive services, 1,6,8,12 worse diabetes care, 1,2,15 and fewer indicated cardiac interventions. 7,16 Moreover, SES disparities exist even among fully insured patients. 4,5,8,13 Eliminating disparities in health and health care is a top priority of the National Institutes of Health and one of the overarching goals of Healthy People 2010. 17,18 SES is a complex characteristic, generally understood to encompass not only income and education level, the measures most commonly used, but also a wide range of associated factors that may affect the quality of health care patients receive, including insurance status, access to care, patients' health beliefs, and many facets of the doctor-patient relationship, such as trust and communication. 10,19,[20][21][22] Little is known, however, about how low SES ultimately infl uences physicians' decision making regarding clinical management of patients and thus how SES may contribute to measured disparities in quality of care.Susannah M. Bernheim, MD, MHS 1,2 Joseph S. Ross MD, MHS 3,4 Harlan M. Krumholz, MD, SM 2,5,6,7 Elizabeth H. Bradley, PhD S O CIOECONO MIC S TAT US A ND C L INIC A L DECISIONSIn the current health care environment...

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“…Spertus et al 23 carried out a study with the objective of verifying the impact of the difficulty presented by the patient in maintaining health care measures after coronary revascularization, through the functional health status. Worsening in the SAQ scores was observed in patients that reported such difficulty, regardless of the revascularization strategies.…”

Section: Cardiovascular Eventsmentioning

confidence: 99%

Preditores de mudança na qualidade de vida após um evento coronariano agudo

Souza¹,

Quadros²,

Maestri³

et al. 2008

Arq. Bras. Cardiol.

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Effect of Difficulty Affording Health Care on Health Status After Coronary Revascularization

Abstract: Background-An

Cited by 25 publications

References 23 publications

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Influence of Patients' Socioeconomic Status on Clinical Management Decisions: A Qualitative Study

Preditores de mudança na qualidade de vida após um evento coronariano agudo

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