Healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions

Figures & data

Table 1 Demographic, medical, and other health-related characteristics of survey respondents (N=332)

Site (N, %)
Mayo Clinic	178 (54)
Hennepin County Medical Center	154 (46)
Mean age in years (SD)	65.9 (11.0)
Range	26–90
Gender (N, %)
Female	185 (56)
Male	147 (44)
Race (N, %)
White	241 (73)
Black/African-American	51 (15)
Mixed	10 (3)
Asian	8 (2)
Native American/American Indian	6 (2)
Missing	16 (5)
Hispanic/Latino ethnicity (N, %)	11 (3)
Education level (N, %)
Some college/associate’s degree	119 (36)
College graduate (B.A., B.S., advanced degree)	113 (34)
High school graduate or less	89 (27)
Missing	11 (3)
No of chronic conditions (N, %)
2	103 (31)
3	112 (34)
≥4	117 (35)
Median no of conditions	3.0
Diagnosed chronic conditions (N, %)
Hypertension	254 (77)
Disorders of lipid metabolism (including hypercholesterolemia)	252 (76)
Diabetes mellitus (type 1 or 2)	120 (36)
Osteoarthritis	119 (36)
Coronary artery disease	63 (19)
Asthma	47 (14)
Chronic kidney disease	44 (13)
Depression	44 (13)
Glaucoma	41 (12)
COPD	34 (10)
Hepatitis (B and C)	28 (9)
Congestive heart failure	22 (7)
Rheumatoid arthritis	15 (5)
Median no of provider encounters in last 18 months	13.5
No of prescription medications (N, %)
1	11 (3)
2–3	80 (24)
4–5	97 (29)
≥6	111 (34)
Missing	33 (10)
“How would you rate your physical health?” (N, %)
Excellent	14 (4)
Very good	79 (24)
Good	132 (40)
Fair	69 (21)
Poor	30 (9)
Missing	8 (2)
“How would you rate your mental health, including your mood and ability to think?” (N, %)
Excellent	54 (16)
Very good	109 (33)
Good	88 (27)
Fair	59 (18)
Poor	15 (5)
Missing	7 (2)
Adherence to medications in a typical week? (N, %)
Always take all medications	260 (78)
Usually/sometimes take all medications	51 (15)
Missing	21 (6)
Mean healthcare provider rating (SD) (0 – worst to 10 – best)	8.7 (1.7)
Range	0–10

Table 2 Correlation (r) of healthcare provider relational quality scale with other measures (zero-order and partial)

Correlate measure or variable	Healthcare provider relational qualitya	Healthcare providerb relational quality, controlling for physical health	Healthcare providerb relational quality, controlling for mental health
Chronic condition distressc	−0.31***	−0.26***	−0.20**
PETS Medical Information Burdend	−0.47***	−0.42***	−0.36***
PETS Difficulty with Healthcare Servicesd	−0.55***	−0.55***	−0.51***
PETS Physical/Mental Exhaustiond	−0.33***	−0.34***	−0.25***
TSQM Medication Conveniencee	0.26***	0.20**	0.14*
PMCSM (self-efficacy)f	0.33***	0.23***	0.16**
Health care provider rating (0 – worst to 10 – best)	0.55***	0.59***	0.58***
No of chronic conditions	−0.02	0.01	0.01
No of provider encounters (last 18 months)	−0.05	−0.02	−0.03
No of prescription medications	−0.01	0.06	0.06

Notes:

a Zero-order (bivariate) correlations.

b Partial correlations controlling for the indicated variable.

c Higher score indicates greater distress.

d PETS: higher scores indicate greater treatment burden.

e TSQM: medication convenience scale, higher score indicates greater medication convenience.

f PMCSM: higher score indicates greater self-efficacy for self-management.

* P<0.05 (1-tailed);

** P<0.01 (1-tailed);

*** P<0.001 (1-tailed).

Abbreviations: PETS, Patient Experience with Treatment and Self-management; TSQM, Treatment Satisfaction Questionnaire for Medication; PMCSM, Perceived Medical Condition Self-management.

Table 3 Correlations of healthcare provider relational quality scale items with distress, treatment burden, self-efficacy, and satisfaction with providera

Healthcare provider relational quality itemsb	Chronic condition distressc	PETSd Medical Information Burden	PETSd Difficulty with Healthcare Services	PETSd Physical/Mental Exhaustion	TSQMe Medication Convenience	PMCSMf	Provider ratingg (0–10)	Mean correlation and median rank
My healthcare provider(s) listens carefully to me	−0.26***	−0.42***	−0.51***	−0.30***	0.21***	0.27***	0.53***	0.36
	4	3	2	3	6	5	2	3
It is easy for me to communicate with my healthcare provider(s)	−0.27***	−0.45***	−0.50***	−0.28***	0.24***	0.27***	0.47***	0.35
	3	1	4	4	2	5	5	4
My healthcare provider(s) treats me with dignity and respect	−0.26***	−0.41***	−0.46***	−0.26***	0.22***	0.31***	0.49***	0.34
	4	4	6	6	5	2	4	4
My healthcare provider(s) is up-to-date on my medical history	−0.23***	−0.39***	−0.48***	−0.28***	0.27***	0.27***	0.40***	0.33
	7	7	5	4	1	5	7	5
My healthcare provider(s) spends enough time with me	−0.31***	−0.40***	−0.52***	−0.36***	0.24***	0.28***	0.53***	0.38
	2	5	1	1	2	4	2	2
My healthcare provider(s) treats me as a whole person	−0.25***	−0.40***	−0.46***	−0.26***	0.20***	0.30***	0.47***	0.33
	6	5	6	6	7	3	5	6
I have trust in my healthcare provider(s)	−0.33***	−0.44***	−0.51***	−0.33***	0.24***	0.36***	0.54***	0.39
	1	2	2	2	2	1	1	2

Notes:

a Numbers in each cell of the table include pairwise correlations (r) followed below by the relative ranking of the magnitude (size) of each correlation within each outcome measure (ie, ordered rankings of magnitudes within each column). The last column indicates the mean of the correlations across the outcome measures and the median rank of the rank-ordered correlation magnitudes across the outcome measures.

b Higher score indicates better relation with provider.

c Higher score indicates more distress.

d PETS: higher score indicates more burden.

e Higher score indicates more convenient.

f Higher score indicates greater self-efficacy.

g Higher rating indicates greater satisfaction with healthcare providers.

*** P<0.001 (1-tailed).

Abbreviations: PETS, Patient Experience with Treatment and Self-management; TSQM, Treatment Satisfaction Questionnaire for Medication; PMCSM, Perceived Medical Condition Self-management.

Figure 1 Mean healthcare provider relational quality items by patient-reported medication adherence with 95% confidence intervals.

Abbreviation: ES, effect size.

Table S1 Medical Information Burden, Difficulty with Healthcare Services, and Physical/Mental Exhaustion due to self-management scales from the Patient Experience with Treatment and Self-management

Medical Information Burden

In the past 4 weeks, how easy/difficult has it been to…

– Learn about your health problem(s)?

– Learn what foods you should eat to stay healthy?

– Find information on the medications that you have to take?

– Understand changes to your treatment plan?

– Understand the reasons why you are taking some medicines?

– Find sources of medical information that you trust?

– Understand advice from different healthcare providers?

Responses: very easy, easy, neither easy nor difficulty, difficult, very difficult, not applicable

Difficulty with Healthcare Services

Thinking about your health care, how much do you agree/disagree with the following?

– I have problems with different healthcare providers not communicating with each other about my medical care

– I have to see too many different specialists for my health problem(s) or illness(es)

– I have problems filling out forms related to my health care

– I have problems getting appointments at times that are convenient for me

– I have problems getting appointments with a specialist

– I have to wait too long at my medical appointments

– I have to wait too long at the pharmacy for my medicine

Responses: strongly agree, agree, disagree, strongly disagree, not applicable

Physical/Mental Exhaustion due to self-management

In the past 4 weeks, how often did your self-care make you feel…

– Angry?

– Preoccupied?

– Depressed?

– Worn out?

– Frustrated?

Responses: never, rarely, sometimes, often, always