Transcript Style B 36 by 48 wide - University of Wisconsin–Madison

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
Introduction
Methods
 Patient info availability during
elderly primary care visits is a
safety issue
Study design
Survey questionnaire
Analysis
 Randomized controlled trial of a pre-visit planning
intervention
 Post-visit survey for doctors & patients:
 Scant primary care research on
patient & physician perceptions
of safety of care & congruency of
perceptions
 Pre-data collection: April – December 2011
 8 Q’s: how much patient info was available for
visit
 Responses grouped into 3 info
availability categories: 1-2 (low), 3-5
(medium), & 6-7 (high)
Setting & Participants
 Example:
 Knowledge of discrepancies is
useful to improve the safety and
patient centeredness
Research Goal
 Determine congruency of
perceptions btw physicians &
elderly patients of physician
knowledge of patient information
during a primary care visit.
 4 Primary care clinics in Southwest/Central WI
• P: Did this doctor have all the information
he or she needed for the visit?
 16 primary care physicians, 4 per clinic
• D: Was there information missing from
today’s visit?
 48 - 50 patients age 65 or older per physician
 Question scale: 1=None, 2 = A little,
3 = Some, 4 = Moderately, 5 = Pretty Much,
6 = Very Much, 7 = Completely
Patient Characteristics
# Patients
Mean age, years
Female (%)
% w/ Chronic health conditions
755
76
63
91% 1, 61% >= 2
 Descriptive statistics used to
calculate % response in each
category for physicians & patients
and congruency of response
category for each visit
 Chi-square used to compare
response congruency btw
physicians & patients for each visit
Results
 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
Conclusions
 Physicians often perceive they
are missing important clinical
information at the end of elderly
primary care visits
Table 1: Congruency Between Patient and Doctor Responses
(P=Patient, D=Doctor)
Question
% of Responses in Each
Category
n
(visits)
1. Knowledge about ongoing
medical problems
700
2. Have all the information
needed
704
3. Knowledge about visits to other
health professionals
638
4. Knowledge about results of
tests and procedures
681
5. Knowledge about medications
705
6. Knowledge about care and
medication cost concerns
563
7. Knowledge about health
concerns
700
8. Knowledge about main
reason for visit
705
P
D
P
D
P
D
P
D
P
D
P
D
P
D
P
D
1-2
2%
5%
0%
3%
3%
3%
2%
3%
1%
3%
5%
2%
1%
8%
1%
5%
3-5
13%
34%
12%
24%
18%
15%
11%
14%
7%
15%
17%
16%
10%
38%
7%
29%
6-7
85%
61%
88%
73%
80%
82%
87%
83%
92%
83%
78%
83%
89%
54%
93%
66%
P=D
Ideal
State
Same
Score
57%
P=D=
6,7
P>D
Patient
Score
Higher
P<D
Patient
Score
Lower
P
value
53%
34%
8%
0.000
70%
66%
23%
8%
0.000
72%
68%
13%
15%
0.000
76%
74%
15%
10%
0.000
77%
76%
16%
7%
0.001
67%
65%
14%
19%
0.001
52%
48%
42%
6%
0.000
65%
63%
32%
4%
0.000
 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
Grant support: Agency for Healthcare
Research & Quality R01 , PI: Karsh /
Wetterneck