The Role of Social Determinants of Health and Medical Home Status in Caregivers' Perception of Health Provider Communication

Introduction: Research shows health providers make assumptions about help-seekers based on social determinants of health (SDH) including race, education, and income. These assumptions impact providers’ interactions with help-seekers. Unequal treatment in health care based on SDH contributes to health disparities by reducing quality of care and discouraging help-seeking. Patient-provider communication is especially critical when patients require ongoing care and health management across settings such as the case for children with special health care needs (CSHN). Although medical homes (MedHomes) serve as a hub for health management, many CSHN in the US are without one. The frequent patient/caregiver-provider contact at MedHomes may also serve to reduce SDH-related biases in care. However, little research has explored whether having a MedHome can attenuate SDH biases in caregiver-provider communication impacting care. This study explored the relationship between SDH and caregivers’ perceived interactions with health care providers for CSHN with and without MedHomes.

Methods: Data were acquired from 2011-2012 National Survey of Children’s Health. Only caregivers of CSHN (n= 18,181; ~48% no MedHome) were included. Caregivers provided perceptions on their interactions with providers in the past year including time spent with CSHN, partnership in care, and providers’ listening, respecting values/customs, and providing specific health information. Responses were analyzed independently and using an average score. Predictor variables included race/ethnicity, poverty level, caregiver’s education, insurance type, and child mental health special needs status (MHSN). Separate multiple regressions were modeled for participants with and without MedHomes. Secondary analyses determined if regression weights were comparable across both groups.

Results: Significant predictors of caregiver-provider communication perceptions differed based on MedHome status. All SDH variables predicted average caregiver-provider communication perceptions for non-MedHome and all but poverty level was significant in the MedHome group. Select results from individual question models include race/ethnicity, education, and poverty level predicted time spent with CSHN for non-MedHome but not for MedHome group. For non-MedHome, all SDH except insurance type was predictive of sensitivity to family values/customs, while no significant relationships were found in MedHome group. Regarding partnership in CSHN care, race/ethnicity, income and MSHN were significant for non-MedHome and no variables were significant for MedHome group.

Conclusion: Results suggest that there are underlying differences in perceptions of caregiver-provider communication in MedHome vs. non-MedHome. SDH being a stronger predictor of caregiver-provider communications in non-MedHome than MedHome suggests that having a MedHome may be protective for those with SDH that place them at risk for health disparities.