OBJECTIVE: To determine whether an intervention designed to improve patient-physician communication increases the frequency with which physicians elicit patients’ concerns, changes other communication behaviors, and improves health care outcomes.
DESIGN: Pretest-posttest design with random assignment of physicians to intervention or control groups.
SETTING: General medicine clinics of a university-affiliated Veterans Affairs Hospital.
PATZEWTS/PARTICIPANTS: Forty-two physicians and 348 continuity care patients taking prescription medications for chronic medical conditions.
INTERVENTIONS: Intervention group physicians received 4.5 hours of training on eliciting and responding to patients’ concerns and requests, and their patients filled out the Patient Requests for Services Questionnaire prior to a subsequent clinic visit. Control group physicians received 4.5 hours of training in medical decision-making.
MEASUREMENTS AND MAIN RESULTS: The frequency with which physicians elicited all of a patient’s concerns increased in the intervention group as compared with the control group (p=.032). Patients perceptions of the amount of information received from the physician did increase significantly (p<.05), but the actual magnitude of change was small. A measure of patient satisfaction with the physicians was high at baseline and also showed no significant change after the intervention. Likewise, the intervention was not associated with changes in patient compliance with medications or appointments, nor were there any effects on outpatient utilization.
CONCLUSIONS: A low-intensity intervention changed physician behavior but had no effect on patient outcomes such as satisfaction, compliance, or utilization. Interventions may need to focus on physicians and patients to have the greatest effect.
doctor-patient communication patient satisfaction ambulatory care
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Sideris DA, Tsouna-Hadjis P, Toumanidis ST, et al. Attitudinal educational objectives at therapeutic consultation: measures of performance, educational approach and education. Med Educ. 1986;20:307–13.PubMedGoogle Scholar
Bass MJ, Buck C, Turner L, et al. The physician’s actions and the outcomes of illness in family practice. J Fam Pract. 1986;23:43–47.PubMedGoogle Scholar
Greenfield S. Kaplan SH, Ware JE, et al. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.PubMedCrossRefGoogle Scholar
Roter DL. Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Ed Monog. 1977;5:281–315.Google Scholar
Swain MA, Steckel SB. Influencing adherence among hypertensives. Res Nurs Health. 1981;4:213–22.PubMedGoogle Scholar
Robinson EJ, Whitfield MJ. Improving the efficiency of patients’ comprehension monitoring: a way of increasing patients’ participation in general practice consultations. Soc Sci Med. 1985;21:915–9.PubMedCrossRefGoogle Scholar
Bertakis KD, Roter DL, Putnam SM. The relationship of physician medical Interview style to patient satisfaction. J Fam Pract. 1991;32:175–81.PubMedGoogle Scholar
Robbins JA, Bertakis KD, Helms LJ, et al. The influence of physician practice behaviors on patient satisfaction. Fam Med. 1993;25:17–20.PubMedGoogle Scholar
Greenfield S, Kaplan SH, Ware JE Jr, et al. Patients’ participation in medical care: effect on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.PubMedCrossRefGoogle Scholar
Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(Suppl):S110–27.PubMedCrossRefGoogle Scholar
Kaplan SH, Greenfield S, Ware JE, Jr. Impact of the doctor-patient relationship on outcomes of chronic disease. In: Stewart MA, Roter D, eds. Communicating with Medical Patients. Beverly Hills, CA: Sage Publications, 1989;228–45.Google Scholar
Green LW, Kreuter MW, Deeds SG, Partridge KB. Health Education Planning: A Diagnostic Approach. Palo Alto, CA: Mayfield Publishing, 1980.Google Scholar
Buchner DM, Carter WB, Inui TS. The relationship of attitude changes to compliance with Influenza immunization: a prospective study. Med Care. 1985;23:771–9.PubMedCrossRefGoogle Scholar
Meyer D, Leventhal H, Gutmann M. Common-sense models of illness: the example of hypertension. Health Psychol. 1985;4:115–35.PubMedCrossRefGoogle Scholar
Bensing JM, Sluijs EM. Evaluation of an interview training course for general practitioners. Soc Sci Med. 1985;20:737–44.PubMedCrossRefGoogle Scholar
Bird J, Lindley P. Interviewing skill: the effect of ultra-brief training for general practitioners. A preliminary report. Med Educ. 1979;13:349–55.PubMedGoogle Scholar
Inui TS, Yourtee EL, Williamson JW. Improved outcomes in hypertension after physician tutorials: a controlled trial. Ann Intern Med. 1976;84:646–51.PubMedGoogle Scholar
Kramer D, Ber R, Moore M. Impact of workshop on students’ and physicians’ rejecting behaviors in patient interviews. J Med Educ. 1987;62:904–10.PubMedGoogle Scholar
Verby JE, Holden P, Davis RH. Peer review of consultations in primary care: the use of audiovisual recordings. BMJ. 1979;1:1686–8.PubMedCrossRefGoogle Scholar
Adler LM, Ware JE, Jr., Enelow AJ. Changes in medical Interviewing style after instruction with two closed-circuit television techniques. J Med Educ. 1970;45:21–8.PubMedGoogle Scholar
Cope DW, Linn LS, Leake BD, Barrett PA. Modification of residents’ behavior by preceptor feedback of patient satisfaction. J Gen Intern Med. 1986;1:394–8.PubMedCrossRefGoogle Scholar
Betchart NS, Anderson DG, Thompson TL, Mumford E. A tutorial approach to improving medical students’ interviewing skills. J Med Educ. 1984;59:431–3.PubMedGoogle Scholar
Mason JL, Barkley SE, Kappelman MM, et al. Evaluation of a self-instructional method for improving doctor-patient communication. J Med Educ. 1988;63:629–35.PubMedGoogle Scholar
Quirk M, Babineau RA. Teaching interviewing skills to students in clinical years: comparative analysis of three strategies. J Med Educ. 1982;57:939–41.PubMedGoogle Scholar
Simek-Downing L, Quirk M. Videotape analyses of medical students’ interviewing skills. Fam Med. 1985;17:57–60.PubMedGoogle Scholar
Scheldt PC, Lazoritz S, Ebbeling WL, et al. Evaluation of system providing feedback to students on videotaped patient encounters. J Med Educ. 1986;61:585–90.Google Scholar
Werner A, Schneider JM. Teaching medical students interactional skills: a research-based course in the doctor-patient relationship. N Engl J Med. 1974;290:1232–7.PubMedCrossRefGoogle Scholar
Roter DL, Cole KA, Kern DE, et al. An evaluation of residency training in interviewing skills and the psychosocial domain of medical practice. J Gen Intern Med. 1990;5:347–54.PubMedGoogle Scholar
Levinson W, Roter D. The effects of two continuing Medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993;8:318–24.PubMedGoogle Scholar
Bertakis KD. A method of increasing patient retention and satisfaction. J Fam Pract. 1977;5:217–22.PubMedGoogle Scholar
Putnam SM, Stiles WB, Jacob MC, James SA. Patient exposition and physician explanation in Initial medical interviews and outcomes of clinical visits. Med Care. 1985;23:74–83.PubMedCrossRefGoogle Scholar
Maiman LA, Becker MH, Liptak GS, et al. Improving pediatricians’ compliance-enhancing practices: a randomized trial. Am J Dis Child. 1988;142:773–9.PubMedGoogle Scholar
Ockene JK, Quirk ME, Goldberg RJ, et al. A residents’ training program for the development of smoking intervention skills. Arch Intern Med. 1988;148:1039–45.PubMedCrossRefGoogle Scholar
Ockene JK, Goldberg R, Kristeller J, et al. The physician-delivered smoking intervention project. Paper presented at 116th annual meeting of the American Public Health Association, Boston, November 1988.Google Scholar
Roter D, Hall J, Katz N. Patient-physician communication: a descriptive summary of the literature. Patient Educ Counsel. 1988;12:99–119.CrossRefGoogle Scholar
Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior In medical encounters. Med Care. 1988;26:657–75.PubMedCrossRefGoogle Scholar
Joos SK, Hickam DH. How health professionals influence health behavior. In: Glanz K, Lewis FM, Rimer BK, eds. Health behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass Publishers, 1990;216–41.Google Scholar
Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24:351–7.PubMedCrossRefGoogle Scholar
Uhlmann RF, Inui TS, Pecoraro RE, Carter WB. Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes. J Gen Intern Med. 1988;3:458–63.PubMedCrossRefGoogle Scholar
Joos SK, Hickam DH, Borders L. Patient desires and satisfaction in a general medicine clinic. Public Health Rep. 1993;108:751–9.PubMedGoogle Scholar
Kravitz RL, Cope DW, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visits. J Gen Intern Med. 1994;9:75–81.PubMedGoogle Scholar
Linn LS, Brook RH, Clark VA, et al. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care. 1985;23;1171–8.PubMedCrossRefGoogle Scholar
Linn LS, Yager Y, Cope D, Leake B. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA. 1985;254:2775–82.PubMedCrossRefGoogle Scholar
Linn LS, DiMatteo MR, Cope DW, Robbins A. Measuring physicians’ humanistic attitudes, values, and behaviors. Med Care. 1987;25:504–15.PubMedCrossRefGoogle Scholar
Krantz DS, Baum A, Wideman M. Assessment of preferences for self-treatment and information in health care. J Pers Soc Psychol. 1980;39:977–90.PubMedCrossRefGoogle Scholar
Kramer MS, Feinstein AR. Clinical biostatistics LIV. The biostatistics of concordance. Clin Pharmacol Ther. 1981;29:111–23.PubMedCrossRefGoogle Scholar
Carter WB, Inui TS. How Patients Judge the Humanistic Skills of their Physicians. Philadelphia: American Board of Internal Medicine Final Report on the Patient Satisfaction Questionnaire Project, 1989.Google Scholar
Hays RD, DiMatteo MR. Key issues and suggestions for patient compliance assessment: sources of information, focus of measures, and nature of response options. J Compliance Health Care. 1987;2:37–54.Google Scholar
Steiner JF, Koepsell TD, Fihn SD, Inui TS. A general method of compliance assessment using centralized pharmacy records: description and validation. Med Care. 1988;26:814–23.PubMedCrossRefGoogle Scholar
Sackett DL. A compliance practicum for the busy practitioner. In: Haynes RB, Taylor DW, Sackett SL, eds. Compliance in Health Care. Baltimore: Johns Hopkins University Press, 1979; 286–94.Google Scholar
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24;67–74.PubMedCrossRefGoogle Scholar
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.CrossRefGoogle Scholar
Donner A, Mar N. Methods for comparing event rates in intervention studies when the unit of allocation is a cluster. Am J Epidemiol. 1994;140:279–89.PubMedGoogle Scholar
Efron B. Regression and ANOVA with zero-one data: measures of residual variation. J Am Stat Assoc. 1978;73:113–21.CrossRefGoogle Scholar
Norusis MJ. SPSS Base Manual, Advanced Statistics and Professional Statistics 6.1. SPSS, Inc., Chicago, IL, 1994.Google Scholar