| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
|
|
|
|||||||
|
|||||||||
TRACK to:
|
|
Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Patient-Centered Health Policy
Patient-Centered Communication and Diagnostic Testing: A Focus on Methodological Challenges
|
|
|||
|
Jacob P. Prunuske, Salt Lake City, USA Physician, University of Utah Department of Family & Preventive Medicine
Send response to journal:
|
Dr. Epstein and his colleagues suggest patient-centered communication is associated with lower diagnostic testing expenditures. Family physicians should strive for excellence in providing cost-efficient, quality health care. The current financial model for primary care physicians, including pressure to see more patients for inadequate E&M reimbursement, does not encourage patient-centered communication. A critical question, not directly addressed in this study, is whether patient-centered communication could improve quality of care to a level that would be rewarded in a pay-for-performance financial model. From a health policy perspective, can we improve health care quality and minimize diagnostic testing to the point where we see a reduction in health insurance premiums? Improved quality of care and lower health insurance premiums are true patient-centered outcomes, and would be additional benefits to patient- centered communication. Competing interests: None declared |
|||
|
|
|||
|
Christos D Lionis, Hearklion, Greece Associate Professor of Social and Family Medicine, School of Medicine, University of Crete
Send response to journal:
|
Epstein et al discuss in their paper, which recently appeared in the September/October issue of Annals of Family Medicine, the potential association between patient-centered communication and diagnostic testing. They report that patient-centered communication is associated with fewer diagnostic testing expenditures and increased visit length. They have extensively discussed the study limitations as well as the benefits and limitations of the standardized patients used in their study. Beyond the methodological considerations and their potential effects on the study's external validity, this report opens a challenging debate for both family physicians and policy makers, who are struggling to reduce high healthcare costs while equitably allocating resources. It is obvious that further studies should answer the question “is this approach, based on patient-centered communication, cheaper?” introducing a “cost-minimization” or “cost-effectiveness” analysis. The authors of this study have stated that “it was unclear whether the reduction in testing affected the quality of care”. Pharmacy expenditures have also not been measured, although empirical data from my country (Greece) support that those primary care physicians who practice with a biomedical style prescribe more than the others. It is an interesting question to what extent family physicians who scored high in doctor-patient communication were choosing tests that generated a high likelihood ratio. It is too early to judge whether such physicians’ performance altered the post-test probability of certain tests in selected conditions, indicating a need for sensitivity analysis. As the authors stated “all these should be confirmed in future randomized trials”. Competing interests: None declared |
|||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
TRACK: