Impact of Self-Reported Patient-Provider Communication on the Use of High- and Low-Value Care Among U.S. Adults.

Abstract

Effective patient-provider communication may promote high-value services while discouraging low-value services. This study examined the associations between patient-provider communication and the use of high- and low-value services among U.S. adults. A cross-sectional study using the 2010-2021 Medical Expenditure Panel Survey was conducted in 2025. Self-reported patient-provider communication was assessed in 4 domains (attentive listening, clear explanation, respectfulness, and time spent) and categorized as low versus moderate/high. Outcomes include 10 high-value services (appropriate cancer screenings, diagnostic and preventive tests, and diabetes care) and 12 low-value services (inappropriate cancer screenings, medication use, and imaging tests). Inverse probability of treatment weighting was applied to balance covariates, followed by weighted generalized linear models to estimate adjusted mean differences in the use of high- and low-value services across levels of patient-provider communication. Adults reporting moderate/high communication had consistently greater use of all 10 high-value services than those reporting low communication, with adjusted differences ranging from +1.7 percentage points (95% CI=1.2, 2.2) for blood pressure measurement to +8.8 (95% CI=6.8, 10.8) for breast cancer screening. For low-value services, adults reporting moderate/high communication showed increased use of antibiotics for influenza (+3.1, 95% CI=1.1, 5.0) but lower use of opioids for headaches (-2.3, 95% CI= -3.7, -0.8) and 3 back pain-related services: opioids (-6.7, 95% CI= -9.8, -3.6), magnetic resonance imaging/computed tomography scans (-4.2, 95% CI= -4.7, -3.7), and radiographs (-2.3, 95% CI= -4.2, -0.4). Better patient-provider communication was consistently associated with greater use of high-value services, but associations with low-value services were mixed. Efforts to improve communication may help promote high-value care; however, reducing low-value care may require additional, service-specific approaches beyond communication alone.