TY - JOUR
T1 - Tool to improve patientprovider interactions in adult primary care Randomized controlled pilot study
AU - O'Malley, Patrick G.
AU - Jackson, Jeffrey L.
AU - Becher, Dorothy
AU - Hanson, Janice
AU - Lee, Jeannie K.
AU - Grace, Karen A.
N1 - Funding Information:
The findings of this study were presented at the Society of General Internal Medicine conference in Orlando, Fla, in April 2012. The views expressed here are those of the authors only and are not to be construed as those of the US Department of the Army, the US Department of Defense, or the US Department of Veterans Affairs. This protocol was approved by the US Department of Clinical Investigation at the Walter Reed Army Medical Center in Bethesda, MD, and was federally funded (by the Army Medical US Department of the US Department of Defense, and the US Defense Health Research Program) in collaboration with the University of California Susan Samueli Integrative Health Institute in Irvine. The funders did not participate in the study design, analysis of data, or manuscript preparation. The full protocol can be obtained by e-mailing the corresponding author.
Publisher Copyright:
© 2022 College of Family Physicians of Canada. All rights reserved.
PY - 2022/2/1
Y1 - 2022/2/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85124774628&partnerID=8YFLogxK
U2 - 10.46747/cfp.6802e49
DO - 10.46747/cfp.6802e49
M3 - Article
C2 - 35177515
AN - SCOPUS:85124774628
SN - 0008-350X
VL - 68
SP - E49-E58
JO - Canadian Family Physician
JF - Canadian Family Physician
IS - 2
ER -