In-Person Interviews Connect Caregivers with Community

In addition to successfully reducing preoperative testing for routine cataract surgery and publicly committing to reduce inappropriate antibiotic prescribing, Los Angeles County (LAC) + USC Medical Center recently fielded a survey to determine patient experiences and expectations for low-value care. The results will help LAC+USC, which is a large safety-net health system, improve conversations between patients and clinicians about Choosing Wisely.

The project team included Carmen Carrillo, Miguel Cuevas, Carmen Reyes and Dr. Catherine Sarkisian of UCLA; Ali Stirland and Melina Boudov from the LAC-Department of Public Health; and Beccah Rothschild of Consumer Reports. Together, they worked to design a 10-minute, in-person oral survey aimed at patients waiting at urgent care.

From fall 2016 to early 2017, bilingual interviewers approached a total of 200 English- and Spanish-speaking patients to discuss their reason for the visit, which treatments they expected to get, which treatments they received during previous visits and where they get their health information. A small incentive was provided to interviewees.

The following survey results will inform continuing efforts to reduce unnecessary imaging and antibiotics:

• The sample population was on average 43 years old, consisted mostly of females (64%). The majority were Hispanic (84% of sample), who completed the survey in Spanish (66%).
• About half of the patients interviewed were seeking treatment for upper respiratory infections (URIs) and the other half were seeking treatment for low-back pain. Most of the patients had previously visited urgent care for these conditions.
• Half of the patients with a URI expected to get antibiotics, and many recalled receiving antibiotics during previous visits. Many patients visiting for low-back pain hoped to get medicine for their pain or a test, mainly an X-ray, to find out what was wrong.
• Most patients reported seeking health care information from health providers (80%) and brochures (55%). Many patients didn’t go online, and almost none sought health information on social media.
• Many patients were confident that they understood health care literature and doctors’ advice.

Perhaps as significant as the survey results themselves was the group’s shared recognition that fostering trusting relationships was key to project’s success.

“Creating relationships with different stakeholders throughout the organization through monthly meetings was important when creating the survey,” Reyes said.

Carrillo added, “We sought broad input about what questions to include. LAC+USC staff members were interested in health literacy and insurance coverage. They thought this was a great opportunity to learn more about their patients.”

Cuevas, whom Dr. Sarkisian described as “professional yet warm” when he approached patients and urgent care staff, put everyone at ease and helped foster better dialogue. “A good majority of patients who I approached were more than willing to share their opinions,” Cuevas said. He also presented the survey findings to the core Choosing Wisely partners last summer and the group is seeking wider dissemination by preparing an abstract to present at upcoming conferences.

In addition, the team has ideas about how these learnings can inform changes at LAC+USC, including reviewing patient education information provided in waiting rooms since they know patients access these resources; doing focus groups with patients or integrating more surveys; and further exploring some of the questions that weren’t used in the 2016–17 survey.

“It’s interesting and surprising that patients were very confident that they understood their doctors,” Dr. Sarkisian said. “It would be great if we could measure if they did and if there are any opportunities to improve communications.”