Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status

Authors

Miriam Komaromy, The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Erin Fanning Madden, Department of Sociology, University of Texas, San Antonio, TX, USA
Andrea Zurawski, The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Summers Kalishman, The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Family and Community Medicine, Office of Education at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Kristin Barker, Department of Sociology, University of New Mexico, Albuquerque, NM, USA
Patricia O'Sullivan, The University of California, San Francisco CA, USA
Martin Jurado, The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
Sanjeev Arora, The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

Document Type

Article

Publication Date

3-1-2018

Abstract

OBJECTIVE: Elicit patients' perceptions of factors that facilitate their engagement in care METHODS: In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs.

RESULTS: Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors.

CONCLUSION: These findings illuminate factors promoting "contingent engagement" for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes.

PRACTICE IMPLICATIONS: For these patients, engagement is contingent on healthcare providers' efforts to develop trust and address patients' material needs.

Recommended Citation

Komaromy M, Madden EF, Zurawski A, Kalishman S, Barker K, O'Sullivan P, Jurado M, Arora S. Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status. Patient Educ Couns. 2018 Mar;101(3):524-531. doi: 10.1016/j.pec.2017.08.019. Epub 2017 Sep 1. PMID: 28890084.