Background/Purpose: We previously showed that poverty is associated with the quantity, type, and technical quality of care in SLE.^[1]  Here we assess whether poverty is associated with ratings of interpersonal aspects of care about providers and health plans.

Methods: We analyzed data from the UCSF Lupus Outcomes Study (LOS), a national sample of persons with SLE interviewed annually using a structured telephone survey. The survey includes batteries from the Consumer Assessment of Health Plans (CAHPS) developed by the Agency for Healthcare Research and Quality and the Interpersonal Processes of Care Scales (IPC) developed by Stewart, et al. (Health Serv Res 2007; 42: 1235-1256) for respondents to rate care along six dimensions of interpersonal processes of care about providers (patient-provider communication, shared decision-making, and trust in provider) and health plans (promptness/timeliness of care, care coordination, and assessment of health plan). Scores in the CAHPS and IPC items were transformed to a uniform 0 (lowest) -100 (highest) rating scale.  Ratings on the six dimensions were regressed on whether respondents had household income ≤ 125% of the Federal poverty level for their household size  with and without the following covariates: demographics (age by category, race/ethnicity, language spoken at home), presence and source of health insurance (public, employer, other), HMO vs. fee-for-service coverage, specialty of main SLE provider, and health status (BILD index of damage, SLAQ index of activity, and CESD index of depressive symptoms).

Results: In 2012, the LOS included 793 respondents living in 40 states. Mean (SD, range) age was 52 years(13, 20-86), duration of SLE was 19 years(9, 1-55), SLAQ was 11(8, 0-47) and BILD was 2.1(2.1, 0-13); 93% were female, 42% non-white, 19% ≤ high school, and 16% met the study definition of poverty. For the six dimensions evaluated, highest ratings were for patient/provider communication (90, 95%CI:89,91), trust in provider (89, 95%CI:88,90), while lowest ratings were for shared decision-making between patient and provider (43, 95%CI:41,46). In bivariate analysis, poverty was associated with significantly lower ratings of patient-provider communication, trust in provider, timeliness of care, and evaluation of health plan. In multivariate analysis, poverty was not associated with any dimension of care.

Conclusion: Unlike objective measures of quantity, type, and technical quality of care, after adjustment, poverty is not associated with subjective assessments of interpersonal processes of care about providers and health plans.

* p<0.05 for difference by poverty status