introduction
DESCRIPTION
Physician & Patient Perceptions of Physician Knowledge about Patient Information during Primary Care Visits Paul Smith 2 , Molly Snellman 3 , Brian Arndt 2 , John Beasley 2 , Roger Brown 4 , Mary Ellen Hagenauer 6 , Kate Judge 2 , Jamie Stone 5,6 , Bentzi Karsh 6 , Tosha Wetterneck 1 - PowerPoint PPT PresentationTRANSCRIPT
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