Reducing Patients’ Unmet Concerns in Primary Care: the Difference One Word Can Make
- 1.1k Downloads
In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed.
To test an intervention to reduce patients’ unmet concerns.
Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys.
Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania.
A volunteer sample of 20 family physicians (participation rate = 80%) and 224 patients approached consecutively within physicians (participation rate = 73%; approximately 11 participating for each enrolled physician) seeking care for an acute condition.
After seeing 4 nonintervention patients, physicians were randomly assigned to solicit additional concerns by asking 1 of the following 2 questions after patients presented their chief concern: “Is there anything else you want to address in the visit today?” (ANY condition) and “Is there something else you want to address in the visit today?” (SOME condition).
Main Outcome Measures
Patients’ unmet concerns: concerns listed on previsit surveys but not addressed during visits, visit time, unanticipated concerns: concerns that were addressed during the visit but not listed on previsit surveys.
Relative to nonintervention cases, the implemented SOME intervention eliminated 78% of unmet concerns (odds ratio (OR) = .154, p = .001). The ANY intervention could not be significantly distinguished from the control condition (p = .122). Neither intervention affected visit length, or patients’; expression of unanticipated concerns not listed in previsit surveys.
Patients’ unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form. Both the learning and implementation of the intervention require very little time.
KEY WORDSunmet concerns unanticipated concerns intervention care physician-patient communication
Funding for this project was provided by the Agency for Healthcare Research and Quality, Grant no. R01 HS13343.
The authors wish to thank Jerome Hoffman MD for his assistance with the training video, and Iris Halldorsdottir, Erika Lamoureaux and Seung-Hee Lee for their assistance in data analysis. Marc Elliott is supported in part by the Centers for Disease Control and Prevention (CDC U48/DP000056). The contents of the publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
John Heritage had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Conflicts of Interest
No author has a potential or actual financial conflict of interest regarding the research reported in this article.
- 8.Lipkin M, Putnam S, Lazare A, eds. The Medical Interview: Clinical Care, Education And Research. New York: Springer; 1995.Google Scholar
- 9.Cohen-Cole SA. The medical interview: The three function approach. St. Louis: Mosby Year Book; 1991.Google Scholar
- 11.Lipkin M, Frankel R, Beckman H, Charon R, Fein O. Performing the interview. In: Lipkin M, Putnam S, Lazare A, eds. The Medical Interview: Clinical Care, Education and Research. New York: Springer; 1995:65–82.Google Scholar
- 12.Seidel HM, Ball JW, Dains JE, Benedict GW. Mosby’s guide to physical examination. 3rd edn. St. Louis: Mosby Year Book; 1995.Google Scholar
- 13.Swartz MH. Textbook of Physical Diagnosis: History and Examination. 4th edn. Philadelphia: W. B. Saunders; 1998.Google Scholar
- 14.Schuman H, Presser S. Questions and Answers in Attitude Surveys: Experiments on Questions Form, Wording and Context. Orlando FL: Academic; 1981.Google Scholar
- 15.Wellman FL. The Art of Cross-Examination. New York: Touchstone; 1997.Google Scholar
- 16.Loftus E. Eyewitness Testimony. Cambridge, MA: Harvard University Press; 1979.Google Scholar
- 17.Clayman S, Heritage J. The News Interview: Journalists and Public Figures on the Air. Cambridge: Cambridge University Press; 2002.Google Scholar
- 18.Boyd E, Heritage J. Taking the patient’s medical history: questioning during comprehensive history taking. In: Heritage J, Maynard D, eds. Communication in Medical Care: Interactions between Primary Care Physicians and Patients. Cambridge, England: Cambridge University Press; 2006.Google Scholar
- 19.Bolinger D. Interrogative Structures of American English. University, Alabama: University of Alabama Press; 1957.Google Scholar
- 20.Borkin A. Polarity items in questions. Chicago Linguistic Society. 1971;7:53–62.Google Scholar
- 21.Horn LR. Some Aspects of Negation. In: Greenberg JH, Ferguson CA, Moravscik EA, eds. Universals of Human Language, Vol.4: Syntax. Stanford, CA: Stanford University Press; 1978:127–210.Google Scholar
- 23.Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley; 1989.Google Scholar
- 24.StataCorp. Stata Statistical Software: Release 9.0. College Station, TX: Stata Corporation; 2005.Google Scholar
- 31.Stein T, Kwan J. Thriving in a busy practice: physician-patient communication training. J Eff Clin Prac. 1999;2:63–70.Google Scholar
- 34.Cassell E. Talking with Patients, Volume 2: Clinical Technique. Cambridge MA: MIT; 1985.Google Scholar
- 35.Heritage J, Maynard DW, eds. Communication in Medical Care: Interactions between Primary Care Physicians and Patients. Cambridge: Cambridge University Press; 2006.Google Scholar
- 36.Stivers T. Prescribing Under Pressure: Parent-Physician Conversations and Antibiotics. New York: Oxford University Press; 2007.Google Scholar