Physician & Patient Perceptions of Physician Knowledge about Patient Information during Primary Care Visits

Paul Smith2, Molly Snellman3, Brian Arndt2, John Beasley2, Roger Brown4, Mary Ellen Hagenauer6, Kate Judge2, Jamie Stone5,6, Bentzi Karsh6, Tosha Wetterneck1

1Department of Medicine, 2Department of Family Medicine University of Wisconsin (UW) School of Medicine and Public Health; 3UW Medical Foundation; 4School of Nursing, 5School of Pharmacy, 6Department of Industrial and Systems Engineering, UW-Madison, WI

Physicians often perceive they are missing important clinical information at the end of elderly primary care visits

Patients & physicians agree on how much information the physician had ½ to ¾ of visits

Patients have valuable info that physicians do not have 4-19% of the time, esp. about other health professional visits & the concerns about costs of care

Strategies are needed to get physicians the information they need before elderly primary care visits

Pre-visit planning intervention underway

Introduction

Results

Patient info availability during elderly primary care visits is a safety issue

Scant primary care research on patient & physician perceptions of safety of care & congruency of perceptions

Knowledge of discrepancies is useful to improve the safety and patient centeredness

Methods

Conclusions

Study design Randomized controlled trial of a pre-visit planning

intervention Pre-data collection: April – December 2011

Setting & Participants 4 Primary care clinics in Southwest/Central WI 16 primary care physicians, 4 per clinic 48 - 50 patients age 65 or older per physician

Patient CharacteristicsResearch Goal Determine congruency of

perceptions btw physicians & elderly patients of physician knowledge of patient information during a primary care visit.

# Patients 755

Mean age, years 76

Female (%) 63

% w/ Chronic health conditions 91% 1, 61% >= 2

Grant support: Agency for Healthcare Research & Quality R01 , PI: Karsh / Wetterneck

Table 1: Congruency Between Patient and Doctor Responses

(P=Patient, D=Doctor) 

% of Responses in Each Category P = D

Ideal State P > D P < D  

Question n (visits)   1-2 3-5 6-7

Same Score

P = D = 6,7

Patient Score Higher

Patient Score Lower

P value

1. Knowledge about ongoing medical problems

700P 2% 13% 85%

57% 53% 34% 8% 0.000D 5% 34% 61%

2. Have all the information needed

704P 0% 12% 88%

70% 66% 23% 8% 0.000D 3% 24% 73%

3. Knowledge about visits to other health professionals

638P 3% 18% 80%

72% 68% 13% 15% 0.000D 3% 15% 82%

4. Knowledge about results of tests and procedures

681P 2% 11% 87%

76% 74% 15% 10% 0.000D 3% 14% 83%

5. Knowledge about medications 705P 1% 7% 92%

77% 76% 16% 7% 0.001D 3% 15% 83%

6. Knowledge about care and medication cost concerns

563P 5% 17% 78%

67% 65% 14% 19% 0.001D 2% 16% 83%

7. Knowledge about health concerns

700P 1% 10% 89%

52% 48% 42% 6% 0.000D 8% 38% 54%

8. Knowledge about main reason for visit

705P 1% 7% 93%

65% 63% 32% 4% 0.000D 5% 29% 66%

Survey questionnairePost-visit survey for doctors & patients:

8 Q’s: how much patient info was available for visit

Example:

• P: Did this doctor have all the information he or she needed for the visit?

• D: Was there information missing from today’s visit?

Question scale: 1=None, 2 = A little, 3 = Some, 4 = Moderately, 5 = Pretty Much, 6 = Very Much, 7 = Completely

For over 1/3 of visits, doctors did not have good info on main reason for visit, health concerns, & ongoing medical problems

Doctors & patients agreed about info availability 48-76% of time Least: health concerns Most: tests/procedures

Patients thought their doctor had more information than their doctor did for 6 of 8 of the measures Dramatic for all info needed,

ongoing medical prob, health concerns & main visit reason

Patients thought their doctor had less information than their doctor did for 2 of 8 measures Concerns about costs of care

& visits to other health professionals

AnalysisResponses grouped into 3 info availability categories: 1-2 (low), 3-5 (medium), & 6-7 (high)Descriptive statistics used to calculate % response in each category for physicians & patients and congruency of response category for each visitChi-square used to compare response congruency btw physicians & patients for each visit