A new UCLA study -- designed to help guide publicly funded health care in Los Angeles County -- revealed high patient satisfaction ratings among L.A. County Department of Health Services (DHS) patients in a wide range of categories, including ease of accessing care. The report also tracked access to prescription medications and access to preventive health care services for specific conditions, including diabetes, colorectal cancer, cervical cancer and breast cancer.
The report, called the Patient Assessment Survey II (PAS II), is a follow-up study to the 1999 PAS report. These surveys track and evaluate a broad range of DHS performance measures, which were begun as part of the Medicaid Waiver Demonstration Project. The recently released study was based on in-person interviews with 2,521 English- and Spanish-speaking patients who visited a county health facility at least once from February-July, 2002. The study was based upon patient perceptions of receipt of care.
Researchers found high ratings of patient satisfaction in several areas: Out of the three-fifths of adult patients who had made an appointment for regular or routine care in the preceding year, a majority (55%), reported always being able to see their doctor as soon as they want. For the three-quarters of pediatric patients who accessed their doctors for regular care, over-half (54%) of parents said they were always seen as soon as they wanted. Almost one-quarter of adult and pediatric patients had made a visit to an emergency department during the preceding year, and almost half (48%) of adult patients and two-thirds (65%) of pediatric cases reported always receiving care as soon as they needed it.
The study also assessed how often adult and pediatric patients received appropriate preventive and condition-specific care. Among adult women, over two-thirds (67%) had received screening for cervical cancer (Pap smear) within one year and this increased to 88% within three years. Likewise, women 50 years of age and older had high rates of screening for breast cancer with 59% having undergone a mammogram within one year, and a total of 79% within two years. However, rates of screening for colorectal cancer, even the use of a fecal occult blood test (FOBT) were low, mirroring the low rates nationally. These findings are comparable with private insurance.
Adult diabetes patients received high rates of condition-specific care such as a dilated retinal exam, cholesterol testing, foot exams and counseling about diabetes treatment and prevention of complications.
"The new study provides valuable quality of care information that can help the Department of Health Services direct its efforts, " said Dr. Allison Diamant, lead researcher and assistant professor, UCLA Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA.
"The results show that even in a time of severe budget constraints and restructuring the L.A. County Department of Health Services is delivering quality of care in certain areas comparable to that received by privately insured patients," said Dr. Steven Asch, a senior author and research professor with the Veterans Affairs Greater Los Angeles Healthcare System and an associate professor with UCLA.
Access to prescription medications is important, and patients often face barriers to receiving the pharmaceuticals that they need. In this study one in ten adults reported not obtaining a necessary prescription medication in the past year; 54% of adults reported that the medication was too expensive while 40% had no insurance. According to Diamant, these findings may reflect the use of health care services outside of the DHS system, because prescription medications are free to patients within the DHS system.
Researchers examined whether patients would alter their care decisions because of recent consolidations in DHS clinics. According to respondents, almost two-thirds (64%) of adult patients will seek care at an alternate county clinic - a strong sign of their interest in staying within the DHS network.
Researchers also investigated whether travel time to health facilities was an issue for patients. However, 38 percent of adult and 50 percent of pediatric patients travel less than 15 minutes to reach their doctor, while just 9 percent of adult and 7 percent of pediatric patients reported travel times greater than one hour. Many patients with private physicians or with employer-sponsored health plans often travel the same amount of time to reach a health plan-approved facility.
Researchers found that wait times to see a physician continues to be an issue. Data show that more than 50 percent of both adult and pediatric patients are waiting more than an hour for their appointments.
The PAS II was performed by a team of researchers from UCLA, RAND, Veterans Affairs Greater Los Angeles Healthcare System, Charles R. Drew University of Medicine and Science, led by Diamant, with input from an advisory group including community representatives.
Participants were interviewed at primary care clinics at DHS facilities including Public-Private Partnership sites - 639 from Comprehensive Health Centers, 574 from Health Centers, 494 from Hospital Outpatient Clinics and 604 from Public-Private Partnership Program Clinics.
Survey respondents and sample:*mean age was 43.1 among adults*68 percent of adults were female*55 percent of children were female*Latinos made up 75% and 87% of the adult and pediatric samples respectively *African-Americans made up 11% and 7% of the adult and pediatric samples respectively*Whites made up 8% and 4% of the adult and pediatric samples respectively*Asian/Pacfic Islander made up 3% and 1% of the adult and pediatric samples respectively*All others were 2% and 1% respectively.
The study funding was provided by the Los Angeles County Department of Health Services. The new survey and the executive summary are available at: http://ladhs.org/planning/PASSII.htm
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