Advertisement

Journal of General Internal Medicine

, Volume 20, Issue 10, pp 935–937 | Cite as

Brief report: Patient-physician agreement as a predictor of outcomes

In patients with back pain
  • Thomas O. Staiger
  • Jeffrey G. Jarvik
  • Richard A. Deyo
  • Brook Martin
  • Clarence H. BraddockIII
Original Articles

Abstract

OBJECTIVE: To determine whether a patient-physician agreement instrument predicts important health outcomes.

DESIGN: Three hundred eighty patients with back pain were enrolled in a comparison of rapid magnetic resonance imaging with standard x-rays. One month later, patients rated agreement with their physician in the following areas: diagnosis, diagnostic plan, and treatment plan. Outcomes included patient satisfaction with care at 1 and 12 months and functional and health status at 12 months.

SETTING: Urban academic and community primary care and specialty clinics.

MEASUREMENTS AND MAIN RESULTS: Higher agreement at 1 month (using a composite sum of scores on the 3 agreement questions) was correlated in univariate analysis with higher patient satisfaction at 1 month (R=.637, P<.001). In multivariate analysis, controlling for 1-month satisfaction and other potential confounders, higher agreement independently predicted better 12-month patient satisfaction (β=0.188, P=.003), mental health (β=1.080, P<.001), social function (β=1.124, P=.001), and vitality (β=1.190, P<.001).

CONCLUSION: Agreement between physicians and patients regarding diagnosis, diagnostic plan, and treatment plan is associated with higher patient satisfaction and better health status outcomes in patients with back pain. Additional research is required to clarify the relationship between physician communication skills, agreement, and patient outcomes.

Key Words

physician-patient communication agreement back pain satisfaction 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jordan JL, Ellis SJ, Chambers R. Defining shared decision making and concordance: are they one and the same? Postgrad Med J. 2002;78:383–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Royal Pharmaceutical Society of Great Britain. From Compliance to Concordance. London: RPSG; 1997.Google Scholar
  3. 3.
    Bass MJ, Buck C, Turner L, Dickie G, Pratt G, Robinson HC. The physician’s actions and the outcome of illness in family practice. J Fam Pract. 1986;23:43–7.PubMedGoogle Scholar
  4. 4.
    Starfield B, Wray C, Hess K, Gross R, Birk PS, D’Lugoff BC. The influence of patient-practitioner agreement on outcome of care. Am J Public Health. 1981;71:127–31.PubMedCrossRefGoogle Scholar
  5. 5.
    Liaw ST, Young D, Farish S. Improving patient-doctor concordance. Fam Pract. 1996;13:427–31.PubMedCrossRefGoogle Scholar
  6. 6.
    Hermoni D, Borkan JM, Pasternak S, et al. Doctor-patient concordance and patient initiative during episodes of low back pain. Br J Gen Pract. 2000;50:809–10.PubMedGoogle Scholar
  7. 7.
    Straand J, Sandvik H. Stopping long-term drug therapy in general practice. Fam Pract. 2001;18:597–601.PubMedCrossRefGoogle Scholar
  8. 8.
    Temple W, Toews J, Fidler H, Lockyer JM, Taenzer P, Parboosingh EJ. Concordance in communication between surgeon and patient. Can J Surg. 1998;41:439–45.PubMedGoogle Scholar
  9. 9.
    Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine. Thousand Oaks, CA: Sage Publications; 1995.Google Scholar
  10. 10.
    Von Korff M, Barlow W, Cherkin D, Deyo RA. Effects of practice style in managing back pain. Ann Intern Med. 1994;121:187–95.Google Scholar
  11. 11.
    Steart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.Google Scholar
  12. 12.
    Stewart MA. Effective physician-patient communication and health outcomes. Can Med Assoc J. 1995;152:1423–32.Google Scholar
  13. 13.
    Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Little P, Everitt H, Williamson I, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908–11.PubMedCrossRefGoogle Scholar
  15. 15.
    Bell RA, Kravitz RL, Thom D, Krupat E, Azari R. Unmet expectations for care and the patient-physician relationship. J Gen Intern Med. 2002;17:817–24.PubMedCrossRefGoogle Scholar
  16. 16.
    Kaplan SH, Greenfield S, Gandek B, Rogers WH, Ware JE. Characteristics of physicians with participatory decision-making styles. Ann Int Med. 1996;124:497–504.PubMedGoogle Scholar
  17. 17.
    Jarvik JG, Hollingworth W, Martin B, et al. The Seattle lumbar imaging project: a randomized controlled trial of rapid MR vs. radiographs for patients with low back pain. JAMA. 2003;289:2863–5.CrossRefGoogle Scholar
  18. 18.
    Deyo RA, Diehl AK. Patient satisfaction with medical care for low-back pain. Spine. 1986;11:28–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Roland M, Morris R. A study of the natural history of back pain. Spine. 1983;8:141–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Ware JE, Shebourne CD. The MOS 36-item short-form health survey (SF-36). Med Care. 1992;30:473–83.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Thomas O. Staiger
    • 1
  • Jeffrey G. Jarvik
    • 2
    • 3
    • 4
  • Richard A. Deyo
    • 1
    • 2
    • 4
  • Brook Martin
    • 4
  • Clarence H. BraddockIII
    • 5
  1. 1.Department of MedicineUniversity of WashingtonSeattleUSA
  2. 2.Department of Health ServicesUniversity of WashingtonSeattleUSA
  3. 3.Departments of Radiology and NeurosurgeryUniversity of WashingtonSeattleUSA
  4. 4.Center for Cost and Outcomes ResearchStanford UniversityStandfordUSA
  5. 5.Department of Medicine and Center for Biomedical EthicsStanford UniversityStanfordUSA

Personalised recommendations