Article Figures & Data
Figures
- Figure 1
CONSORT flow diagram of study physicians and patients.
CONSORT = Consolidated Standards of Reporting Trials; PCP = primary care physician.
Tables
Care Gap Definition Laboratory tests overdue Diabetes and no HbA1c result in past 12 months Overdue for screening or treatment Last mammogram more than 2 years ago (for women aged 50-74 years) Last colorectal cancer screening more than 1 year ago (for adults aged >50 years) Treatment for osteoporosis not started (for adults at high risk for fracture, defined as first fracture among women aged >60 years and men aged >70 years) Not at goal For patients with diabetes, last HbA1c ≥8% For patients with hypertension, last 2 SBP ≥140 mm Hg or last SBP ≥150 mm Hg For patients with cardiovascular disease, last LDL cholesterol level ≥160 mg/dL For patients with persistent asthma, asthma Med Ratio <0 Medication adherence <80% in past year For patients with diabetes, aged <75 years and last HbA1c ≥8% For patients with hypertension and last 2 SBP ≥140 mm Hg For patients with cardiovascular disease and last LDL cholesterol level ≥100 mg/dL Current smoker – Depression monitoring For patients with depression diagnosis, missing PHQ9 Asthma Med Ratio = ratio of controller to total asthma medications; HbA1c = hemoglobin A1c; LDL = low-density lipoprotein; PHQ9 = 9-question depression scale from the Patient Health Questionnaire; SBP = systolic blood pressure.
Characteristic All Physicians(N = 73) Group Intervention Physicians (n = 37) Control Physicians (n = 36) P
ValuePhysicians Age, mean (SD), y 42.2 (8.4) 40.8 (7.7) 43.7 (8.9) .14 Time in practice, mean (SD), y 13.8 (8.8) 12.4 (8.1) 15.1 (9.4) .19 Women, No. (%) 52 (71.2) 25 (67.6) 27 (75.0) .48 Spanish speaking, No. (%) 23 (31.5) 10 (27.0) 13 (36.1) .40 Characteristic All Patients(N = 750) Group Intervention Patients(n = 359) Control Patients(n = 391) P
ValuePatients Women, No. (%) 486 (64.8) 235 (64.2) 251 (64.2) .72 Race/ethnicity, No. (%) .06 African American 212 (28.3) 115 (32.0) 97 (24.8) Asian 54 (7.2) 20 (5.6) 34 (8.7) Hispanic 167 (22.3) 69 (19.2) 98 (25.1) Othera 29 (3.9) 14 (3.9) 15 (3.8) White 288 (38.4) 141 (39.3) 147 (37.6) Age, mean (SD), y 60.8 (11.9) 60.5 (12.2) 60.3 (12.1) .82 New to primary care physician, No. (%) 200 (26.7) 102 (28.4) 98 (25.1) .30 Spanish as primary language, No. (%) 123 (16.4) 46 (12.8) 77 (19.7) .01 Medication count, mean (SD) 2.8 (2.7) 2.8 (2.7) 2.6 (2.6) .26 Diabetes, No. (%) 259 (34.5) 113 (31.5) 146 (37.3) .09 ↵a More than 1 race/ethnicity selected.
How often do you: Physicians Answering “Usually” or “Always,” % All (N = 73) Group Intervention (n = 37) Control (n = 36) P Value Elicit patients’ top concerns? 80.8 83.8 77.8 .52 Get through all the items on your agenda? 61.6 64.9 58.3 .57 Find that patients typically prepared with 1 or 2 topics? 49.3 40.5 58.3 .13 Find that patients raise concerns near the end of the visit? 43.1 44.4 41.7 .81 Have enough time during your visits? 4.1 4.1 0 .24 Note: Choices were “never,” “rarely,” “sometimes,” “usually,” and “always.”
Primary Priority and Subcategory Patients, No. (%) First Priority Second Priority Total Old problem 90 (25.6) 69 (41.8) 159 (30.8) Something has changed 23 (5.9) 26 (14.3) 49 (8.5) I am not getting better from last time 37 (9.4) 18 (9.9) 55 (9.6) I need more explanation 23 (5.9) 13 (7.1) 36 (6.3) New problem 154 (43.9) 0 (0.0) 154 (29.8) I’ve noticed something new 120 (30.6) 0 (0.0) 120 (20.9) I’m having trouble with my usual activities 30 (7.7) 0 (0.0) 30 (5.2) I’m feeling anxious or depressed 14 (3.6) 0 (0.0) 14 (2.4) Medicines 58 (16.5) 20 (12.1) 78 (15.1) Problems with side effects 20 (5.1) 9 (5.0) 29 (5.1) Medicines cost too much 6 (1.5) 2 (1.1) 8 (1.4) Stopped taking 12 (3.1) 2 (1.1) 14 (2.4) A personal concern or other 16 (4.6) 38 (23.0) 54 (10.5) Anxious or depressed 3 (0.8) 13 (7.1) 16 (2.8) Drug or alcohol concerns 0 (0.0) 3 (1.7) 3 (0.5) My personal safety 8 (2.0) 9 (5.0) 17 (3.0) Need something from doctor 29 (8.3) 24 (14.6) 53 (10.3) Referral to a specialist 4 (1.0) 12 (6.6) 16 (2.8) Medication refill 7 (1.8) 5 (2.8) 12 (2.1) Blood test, radiograph, or other test 8 (2.0) 8 (4.4) 16 (2.8) Form filled out 3 (0.8) 3 (1.7) 6 (1.1) Stress at home or at work 4 (1.1) 14 (8.5) 18 (3.5) Caregiving issues 2 (0.5) 5 (2.8) 7 (1.2) Family concerns 2 (0.5) 6 (3.3) 8 (1.4) Financial concerns 0 (0.0) 3 (1.7) 3 (0.5) Note: 5 patients did not select any first-priority concern, and 191 patients did not select any second-priority concern.
Question Patients Answering “Yes, Definitely,” No. (%) Odds Ratio (95% CI) Intervention (n = 333) Control (n = 357) P Value Quality of communication Did you prepare a list of questions for your doctor? 198 (59.5) 160 (44.8) <.01 1.81 (1.33-2.45) Did you tell your doctor about your top concerns at the beginning of the visit? 304 (91.3) 297 (83.2) <.01 2.18 (1.32-3.59) Patient satisfaction Were you satisfied that your care was well organized? 289 (86.8) 321 (89.9) .20 0.74 (0.46-1.18) Autonomy Were you given choices about treatment to think about? 207 (62.2) 214 (59.9) .55 1.10 (0.81-1.49) Patient-centeredness Were you asked for your ideas when a treatment plan was made? 149 (44.7) 160 (44.8) .80 1.05 (0.70-1.58) Were you asked to talk about your goals in caring for your illness? 160 (48.0) 190 (53.2) .25 0.83 (0.60-1.15) Care Gap Measure Patients Whose Physicians Responded “Yes,” No. (%) Odds Ratio (95% CI) All (N = 747) Group Intervention (n = 359) Control (n = 388) P Value All baseline care gaps closed? 394 (52.7) 184 (51.3) 210 (54.1) .52 0.90 (0.65-1.24) Any baseline care gaps closed? 473 (63.3) 221 (61.6) 252 (64.9) .34 0.87 (0.64-1.17) Any new care gaps opened? 165 (22.1) 81 (22.6) 84 (21.6) .67 1.09 (0.74-1.60) No care gaps at end of study? 310 (41.5) 143 (39.8) 167 (43.0) .39 0.88 (0.64-1.19)
Supplemental Figure
Supplemental Figure
Files in this Data Supplement:
- Supplemental data: Figure - PDF file
The Article in Brief
Visit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial
Richard W. Grant , and colleagues
Background There is limited time during primary care visits. This study tests the hypothesis that an information technology tool in the waiting room could help patients identify and express their top visit priorities, which would lead to better visit interactions and improved quality of care.
What This Study Found An information technology tool in waiting rooms of primary care practices helped patients prepare questions and express their concerns to their doctors, but did not reduce gaps in clinical care. The "Visit Planner" tool, which was placed in eight primary care practices, was designed to help adult patients identify priorities for their visit and effectively express them to their clinician. Eligible patients had at least one clinical care gap (eg, not meeting diabetes goals). Of 359 patients in the intervention group, 59 percent (n=198) reported that they "definitely" prepared questions for their doctor, compared to 45 percent (n=160) of control patients. A high percentage of intervention group patients also reported "definitely" expressing their top concerns at the beginning of the doctor visit (91 percent vs 83 percent of control group patients). Patients in both arms of the study reported high levels of satisfaction with their care. Overall, half of study patients (394/747, 53 percent) had all baseline care gaps closed by the end of the 6-month follow-up period. The prevalence of clinical care gaps was reduced by a similar amount in both groups.
Implications
- The Visit Planner successfully guided patients to begin primary care visits by communicating their top care priorities, an important gap in visit interactions. Improving this crucial first step of prioritization, the authors state, can be a building block for the next generation of tools that address communication barriers related to care planning with the ultimate goal of improving clinical care outcomes.
