Educational inequalities in patient-centred care: patients' preferences and experiences.
BACKGROUND
Educational attainment is strongly related to specific health outcomes. The pathway in which individual patient-provider interactions contribute to (re)producing these inequalities has yet to be studied. In this article, the focus is on differences between less and more highly educated patients in their preferences for and experiences with patient-centred care., e.g. shared decision making, receiving understandable explanations and being able to ask questions.


METHODS
Data are derived from several Consumer Quality-index (CQ-index) studies. The CQ-index is a family of standardized instruments which are used in the Netherlands to measure quality of care from the patient's perspective.


RESULTS
The educational level of patients is directly related to the degree of importance patients attribute to specific aspects of patient-centred care. It has a minor influence on the experienced level of shared decision making, but not on experiences regarding other aspects of patient-centred care.


CONCLUSIONS
All patients regard patient-centred care as important and report positive experiences. However, there is a discrepancy between patient preferences for patient-centred care on one hand and the care received on the other. Less educated patients might receive 'too much', and more highly educated patients 'too little' in the domains of communication, information and shared decision making.
NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands. j.rademakers@nivel.nl
Jany
J
Rademakers
Diana
D
Delnoij
Jessica
J
Nijman
Dolf
D
de Boer
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000739:Anecdotes as Topic; D001172:Arthritis, Rheumatoid / Q000628:therapy; D001941:Breast Diseases / Q000628:therapy; D003142:Communication; D003657:Decision Making; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference / Q000523:psychology*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D017678:Sex Distribution; D012923:Social Class; D011795:Surveys and Questionnaires