Visit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial

Richard W. Grant; Courtney Lyles; Connie S. Uratsu; Michelle T. Vo; Elizabeth A. Bayliss; Michele Heisler

doi:10.1370/afm.2352

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Richard W Grant

Published on: 14 March 2019
Maybe our gaps are not their priorities?
Barry Saver

Published on: 13 March 2019

Published on: (14 March 2019)
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Richard W Grant, Research Scientist
We agree with Dr. Saver's comment that patient priorities do not necessarily align with the care gaps that we as primary care physicians are tasked with closing. From a pragmatic perspective, we chose this broadly-defined outcome for our study because of the heterogeneity of general primary care patients enrolled. But from a more philosophical perspective, we agree that small benefits that have a meaningful impact at the...
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We agree with Dr. Saver's comment that patient priorities do not necessarily align with the care gaps that we as primary care physicians are tasked with closing. From a pragmatic perspective, we chose this broadly-defined outcome for our study because of the heterogeneity of general primary care patients enrolled. But from a more philosophical perspective, we agree that small benefits that have a meaningful impact at the population level may not be of the highest priority to individual patients themselves. This underscores the need, in our view, for good communication and long-term patient-provider relationships that encourage real collaboration between patients and their doctors to achieve both immediate as well as longer term goals that are important both to patients and doctors.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (13 March 2019)
Page navigation anchor for Maybe our gaps are not their priorities?
Maybe our gaps are not their priorities?
Barry Saver, Faculty Physician
I was happy to see this done as it has long seemed to me to be an obvious way to facilitate agenda-setting. But I am not surprised that the identified care gaps were not differentially affected by the intervention. Patients' priorities frequently differ from ours and, if we are going to be more patient-centered, that could even mean less time spent on addressing our priorities in a visit if they do not match a patient's...
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I was happy to see this done as it has long seemed to me to be an obvious way to facilitate agenda-setting. But I am not surprised that the identified care gaps were not differentially affected by the intervention. Patients' priorities frequently differ from ours and, if we are going to be more patient-centered, that could even mean less time spent on addressing our priorities in a visit if they do not match a patient's priorities. Pushing a patient to place higher importance on our priorities may or may not be appropriate or beneficial.
Many medical interventions yield modest average benefits, even if they yield substantial population benefits for highly prevalent conditions, such as hypertension. Many patients, if truly informed about benefits of such interventions, might decline them, decreasing "quality." Yet we are measured, judged, and sometimes incentivized on what is easily measured, even if benefits are modest.
I have not seen this tension addressed much in the literature. But we need to deal with it if we believe in truly patient-centered care. Also, eliciting preferences alone clearly is not sufficient to enhance patient autonomy and involvement in planning their care.
Competing interests: None declared
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Competing Interests: None declared.