Effects of physician awareness of symptom-related expectations and mental disorders. A controlled trial. Arch Fam Med 1999;8(2):135-42
Date
04/02/1999Pubmed ID
10101984DOI
10.1001/archfami.8.2.135Scopus ID
2-s2.0-0033094954 (requires institutional sign-in at Scopus site) 46 CitationsAbstract
OBJECTIVE: To study whether physician awareness of symptom-related expectations and mental disorders reduces unmet expectations or improves patient satisfaction.
DESIGN: Prospective, before-after trial, with control (n = 250) and intervention (n = 250) groups. Outcomes were assessed immediately after the index office visit, at 2 weeks, and at 3 months.
SETTING: Ambulatory walk-in clinic.
PARTICIPANTS: Five hundred adults with physical complaints. Exclusion criteria included upper respiratory tract infection and dementia. Follow-up was accomplished in 100% immediately after the visit, 92.6% at 2 weeks, and 82.6% at 3 months.
INTERVENTIONS: Two-hour physician workshop followed by information provided before each visit on patient expectations, illness worry, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorders.
MEASUREMENTS: Symptom-related expectations, satisfaction with care, symptom improvement, functional status, physician-perceived difficulty of the encounter, visit costs, and use of health care services.
RESULTS: Serious illness worry (64%), 1 or more specific expectations (98%), or a DSM-IV disorder (29%) were commonly present in study patients. Intervention patients were less likely to report unmet expectations (odds ratio, 0.52; 95% confidence interval [CI], 0.43-0.97) immediately after the visit and at 2 weeks, less likely to be perceived as difficult by their physician (odds ratio, 0.49; 95% CI, 0.24-0.98), and more likely to be fully satisfied at 2 weeks (odds ratio, 1.63; 95% CI, 1.14-2.00). By 3 months, groups were similar in terms of satisfaction and residual expectations. Symptom improvement occurred in most patients by 2 weeks (70.5%) and 3 months (81.2%), regardless of study group. There was also no difference in patients' serious illness worry during the follow-up. The intervention did not increase visit costs or use of health care services.
CONCLUSION: Identifying symptom-related expectations and mental disorders in patients presenting with physical complaints may improve satisfaction with care at 2-week follow-up and physician-perceived difficulty of the encounter.
Author List
Jackson JL, Kroenke K, Chamberlin JAuthor
Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Ambulatory CareAttitude to Health
Awareness
Female
Humans
Male
Mental Disorders
Middle Aged
Odds Ratio
Patient Satisfaction
Physicians
Prospective Studies
Treatment Outcome