SRF063: When Patients’ Self-Rated Health Surprises: Primary Care Provider Reactions to Patients with Bad/Very Bad Self-Rated Health

Elise Duwe, MD, PhD; Christopher Haymaker


Context: Self-rated health functions as an important and under-utilized marker of vulnerability and high health needs. Additionally poorer self-rated health has been linked to higher health care utilization, cost of care, and distrust of the healthcare system. Self-rated health functions as a risk predictor for poor outcomes, quality of life, morbidity, and mortality. Rarely do providers utilize self-rated health. We define self-rated health as: “In general, how would you rate your health today?” with responses very bad to very good. Objective: To determine primary care providers’ (PCP) reactions to patients who rate their health as bad or very bad at either sick or well visits. Study Design: Descriptive statistical analyses of primary database created weekly with variables: self-rated health, risk score, age, sex, race, zip code, PCP, concern for violence in neighborhood, concern for meeting basic needs, and concern for affording healthcare. Thematic qualitative analysis of PCP reaction to patients with poor health status. Setting and Population: Patients at a Midwest family medicine residency clinic since the beginning of June. Age from newborn to elderly. Inclusion criteria include being seen for a visit at the residency clinic and completing the self-rated health question on intake. Outcome Measures: Primary outcome will be themes from PCP impression of patients’ self-rated health. Secondary outcome is correlation of health status with risk score, age, sex, race, zip code, PCP, concern for violence in neighborhood, concern for meeting basic needs, and concern for affording healthcare. Preliminary Results: Anticipate PCP surprise at poor health status of patient’s with a low risk score and no concerns for marginal status by age, race, class, or gender as well as no social determinants of health risk factors. Conclusions and Next Steps: We seek to develop an intervention for PCPs to better understand why patients rate their health poorly as well as assist patients with resources to improve their self-rated health. Currently transitional care and emergency department follow-up visits have self-rated health status listed as a specific risk factor. We hope to flag all patients at the visit if self-rated health is bad or very bad. One provider already asks all her patients during agenda setting for their health status. Many patients rate their health as okay. There remains a question what to do with this middle of the road health status.
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Jack 11/21/2020

great project. super poster and brief presentation. thanks

Anne Gaglioti 11/22/2020

Really important work Elise- translating a validated HSR measure into front line practices and testing how PCP's perceive the acceptability/utility of this measure. Would be interesting to understand if we can improve acceptability of using this measure in practice though some training around the evidence for SRH. 

Bill Phillips 11/23/2020

A terrific research question. Very interesting. Too much great content for a poster. Sorry not to be able you meet you in person this year. Interested in your next steps. (Hope to see them here at NAPCRG next year.)

Judy Belle Brown 11/23/2020

Hi Elise - can't wait to learn more about the qualitative findings ... Next year at NAPCRG???

lauren.oshman 11/24/2020

First of all, I loved your background during your presentation! Important topic, and I was struck by the number of qualitative themes that I think could be addressed via motivational interviewing in similar interventions. I would also be curious about physician responses and empathy statements during these conversations!

Elise 11/24/2020

Thank you, Lauren! I did worry that our annotations on the map for where we want to travel post COVID did not offend randomly. Excellent idea regarding motivational interviewing. That's a great way to take this idea and push it. It's such an easy and efficient way to assess if a person is OK and when they are not, then what next? MI is a good idea.

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