Tool to improve patient-provider interactions in adult primary care: Randomized controlled pilot study. Can Fam Physician 2022 Feb;68(2):e49-e58
Date
02/19/2022Pubmed ID
35177515Pubmed Central ID
PMC9842177DOI
10.46747/cfp.6802e49Scopus ID
2-s2.0-85124774628 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
OBJECTIVE: To assess whether an intervention to help patients prioritize goals for their visit would improve patient-provider communication and clinical outcomes.
DESIGN: Randomized controlled pilot study.
SETTING: Primary care clinic.
PARTICIPANTS: There were 120 adult hypertensive patients enrolled.
INTERVENTION: Patients were randomized to receive either usual care or a previsit patient activation card developed through a series of focus groups that prompted patients to articulate their needs and set priorities for their clinic visit. Encounters were audiorecorded, transcribed, and assessed using duplicate ratings of patient activation and decision making.
MAIN OUTCOME MEASURES: The primary outcome was change in medication adherence as measured by pill count at 4 and 12 weeks after the initial visit. Secondary outcomes evaluated patient-provider interaction quality (patient satisfaction, patient activation, shared decision making, patient trust, and physicians' perceived difficulty of the encounter), functional status, and blood pressure control.
RESULTS: Of the 120 enrolled patients, 106 completed the baseline visit (mean age of 66 years, 53% women, 57% Black, 36% White). Participants had multiple comorbidities (median number of medications = 8). During the visit, there was greater patient activation in the intervention arm than in the control arm (4.4 vs 3.8, P = .047; ratings were based on a scale from 1 to 10). However, after the visit there were no differences in medication adherence (4 weeks: 45.8% vs 49.5%; 12 weeks: 49.4% vs 51.1%), blood pressure control (4 weeks: 133/78 mm Hg vs 131/77 mm Hg; 12 weeks: 129/77 mm Hg vs 129/76 mm Hg), or encounter satisfaction (78.6% vs 73.8% fully satisfied; P = .63). There were also no differences in shared decision making, patients' trust, or perceived difficulty of the encounter.
CONCLUSION: A single previsit tool designed to prompt patients to set a prioritized agenda improved patient activation during the visit, but did not affect the quality of the interaction or postvisit patient-centred outcomes.
Author List
O'Malley PG, Jackson JL, Becher D, Hanson J, Lee JK, Grace KAAuthor
Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Female
Humans
Male
Medication Adherence
Patient Participation
Patient Satisfaction
Pilot Projects
Primary Health Care
