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Review ArticleSystematic Reviews

Effect on Health-Related Outcomes of Interventions to Alter the Interaction Between Patients and Practitioners: A Systematic Review of Trials

Simon J. Griffin, Ann-Louise Kinmonth, Marijcke W. M. Veltman, Susan Gillard, Julie Grant and Moira Stewart
The Annals of Family Medicine November 2004, 2 (6) 595-608; DOI: https://doi.org/10.1370/afm.142
Simon J. Griffin
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Ann-Louise Kinmonth
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Marijcke W. M. Veltman
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Susan Gillard
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Julie Grant
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Moira Stewart
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    Table 1.

    Characteristics of Included Trials

    Author, YearSetting, CountryPatient GroupHealth OutcomePatients Entered No.Treatment Allocation*Outcome Assessment†DurationPercent Lost to Follow-up
    USA = United States of America; OPD = outpatient department; Aus = Australia; UK = United Kingdom; GP = patient attending in general/family practice; CHD = coronary heart disease.
    * Allocation concealment at treatment allocation was adequate if a clear method (for example central randomization, sealed envelopes or random numbers) was reported.
    † Allocation concealment at outcome assessment was adequate if it was reported that assessors were unaware of participants’ study group allocation.
    ‡ Numbers of patients analyzed in the trial.
    Interventions delivered directly to patients
    Greenfield et al, 198522Hospital OPD, USAChronic disease (peptic ulcer)Subjective45InadequateAdequate8 weeks<30
    Greenfield et al, 198814Hospital OPD, USAChronic disease (diabetes)Objective73InadequateAdequate12 weeks<30
    Kaplan et al, 198921Hospital OPD, USAChronic disease (hypertension)Objective105InadequateInadequate12 weeksMissing
    Thompson et al, 1990a20Primary care, USAOther disease (gynecology)Subjective66AdequateInadequateImmediate>30
    Thompson et al, 1990b20Primary care, USAOther disease (gynecology)Subjective105AdequateInadequateImmediate>30
    Butow et al, 199423Hospital OPD, AusOther disease (cancer)Subjective142InadequateInadequate3 weeks>30
    Street et al, 199524Hospital OPD, USAOther disease (breast cancer)Subjective60InadequateInadequate1 week<30
    McCann & Weinman, 199625Primary care, UKGP non specific diseaseSatisfaction120AdequateAdequateImmediate<30
    Davison & Degner, 199726Hospital OPD, CanadaOther disease (prostate cancer)Subjective60AdequateInadequate6 weeks<30
    Kravitz et al, 199727Primary care, USAOther disease (not specified)Satisfaction396InadequateInadequateImmediate<30
    Fleissig et al, 199928Hospital OPD, UKOther disease (not specified)Satisfaction1,683InadequateAdequateImmediate>30
    Interventions delivered via practitioners
    Thomas, 197829Primary care, UKGP nonspecific diseaseSubjective200InadequateInadequate1 month<30
    Schulman & Swain, 198030Hospital OPD, USAChronic disease (hypertension)Satisfaction105InadequateInadequateImmediate<30
    Evans et al, 198731Primary care, AusGP nonspecific diseaseSubjective400‡InadequateInadequate4 weeksMissing
    Thomas, 198732Primary care, UKGP nonspecific diseaseSubjective200InadequateInadequate2 weeks<30
    Olsson et al, 198933Primary care, SwedenGP nonspecific diseaseSubjective100AdequateAdequate2 days<30
    Savage, 199039Primary care, UKGP nonspecific diseaseSubjective350InadequateInadequate1 week>30
    Evans et al, 199235Hospital OPD, AusOther disease (not specified)SatisfactionMissingInadequateAdequateImmediateMissing
    Roter et al, 199513Primary care, USAGP non specific diseaseSubjective648InadequateAdequate6 months<30
    Smith et al, 199536Primary care, USAOther disease (not specified)Satisfaction181AdequateInadequateImmediateMissing
    Meland et al, 199737,38Primary care, NorwayRisk of disease (CHD)Objective127InadequateInadequate1 year<30
    Kinmonth et al, 199839Primary care, UKChronic disease (diabetes)Objective360AdequateAdequate1 year>30
    Pill et al, 199840Primary care, UKChronic disease (diabetes)Objective190AdequateAdequate18 months<30
    Smith et al, 199841Primary care, USAGP nonspecific diseaseSubjectiveMissingInadequateAdequate4 weeksMissing
    Peters et al, 199942Primary care, UKOther disease (cervical dysplasia)Subjective270AdequateAdequate4 months<30
    Thom et al, 199943Primary care, USAGP nonspecific diseaseOther health related414InadequateInadequate6 months<30
    Brown Betz et al, 199944Primary care, USAGP nonspecific diseaseSatisfaction4,941‡AdequateAdequate3 months<30
    Interventions delivered both to the patient and to the practitioner
    Lewis et al, 199145Primary care, USAGP nonspecific diseaseSubjective141InadequateAdequateImmediate
    Katon et al, 199546Primary care, USAChronic disease (depression)Subjective217InadequateAdequate7 months
    Rubenstein et al, 199547Primary care, USAGP nonspecific diseaseSubjective557AdequateAdequate6 months
    Joos et al, 199648Hospital OPD, USAChronic disease (not specified)Other health related409InadequateInadequate12 months<30
    Hornberger et al, 199749Primary care, USAGP nonspecific diseaseSubjective201InadequateInadequateImmediate<30
    Wagner et al, 199750Hospital OPD, USAChronic disease (epilepsy)Satisfaction163AdequateInadequateImmediate<30
    Maly et al, 199951Primary care, USAChronic disease not specified)Subjective265AdequateAdequate2 weeks<30
    Reuben et al, 199952Community, USAOther disease (multiple types)Objective363AdequateAdequate15 months<30
    • View popup
    Table 2.

    Characteristics of the Interventions in Included Trials

    Author, YearIntervention GroupComparison Group
    Interventions delivered directly to patients
    Greenfield et al, 198522Preconsultation interview, skills training and materialsPreconsultation interview about disease course, treatment, self-care, and adherence to treatment
    Patient activation with attention to emotion and provision of information about treatment decisions
    Greenfield et al, 198814Preconsultation interview, skills training and materialsPreconsultation interview about disease course and treatment
    Patient activation with attention to emotion and provision of information about treatment decisions
    Kaplan et al, 198921Preconsultation interview, skills training and materialsPreconsultation interview about disease course, treatment, and self-care
    Patient activation with attention to emotion and provision of information about treatment decisions
    Thompson et al, 1990a20Preconsultation, list of possible health concerns, and leaflet encouraging question askingUsual care and questionnaire on waiting room facilities
    Patient activation
    Thompson et al, 1990b20Preconsultation, message from physician encouraging question asking, or checklist of information to be obtained during consultationUsual care and questionnaire on waiting room facilities
    Patient activation
    Butow et al, 199423Preconsultation, leaflet encouraging question askingHandout on cancer services available
    Patient activation
    Street et al, 199524Multimedia program providing information about disease and treatment and encouragement to ask questions, explain concerns, and offer opinion in consultationGiven same material in brochure form without treatment options.
    Patient activation with provision of information about disease and treatment and attention to emotion
    McCann & Weinman, 199625Preconsultation, leaflet encouraging questions, and ideas about causes, diagnosis, and treatmentleaflet giving dietary advice
    Patient activation
    Davison & Degner, 199726Preclinic interview facilitating provision of information, encouraging questions and participation in decisionsSocial interview and unfacilitated information pack
    Patient activation and provision of information about disease
    Kravitz et al, 199727Preconsultation, patient completes request for services and is interviewed on expectations for care in consultationUsual care
    Patient activation
    Fleissig et al, 199928Preconsultation help card, and encouragement to ask questionsUsual care
    Patient activation
    Interventions delivered via practitioners
    Thomas, 197829During consultation, provision of positive information about diagnosis and treatmentGiven positive information that there was no illness
    Changes style of information giving
    Schulman & Swain, 198030During consultation, practitioner provided information about hypertension and its management alone, or with contingency contractingUsual care
    Provision of information about disase and discussion of behavior change
    Evans et al, 198731Lecture, booklet, discussionUsual care
    Communication skills training
    Thomas, 198732During consultation, certainty about diagnosis, treatment and prognosisUncertainty about diagnosis
    Changes style of information giving
    Olsson et al, 198933During consultation, positive style, personal, with provision of information about disease (prognosis)Less positive diagnosis, less personal, no information on prognosis
    Changes style of information giving and provides information about disease
    Savage, 199039During consultation, shared style, eliciting patients ideas about symptoms, diagnosis, and treatmentDirective style, giving clear information on diagnosis, treatment and prognosis
    Changes style of information giving
    Evans et al, 199235Lectures small groups and videotape feedbackUsual clerking
    Communication skills training
    Roter et al, 199513Course with simulated psychiatric patients and videosUsual practice
    Communication skills training with attention to emotion and information about disease management
    Smith et al, 199536Communication skills training with discussion of behavior change and skills in disease managementUsual care
    Meland et al, 199737,38Training using video and cognitive self-help materials for patients Discussion of behavior changeUsual care and leaflets
    Kinmonth et al, 199839Communication skills training in listening, eliciting patient’s agenda, and supporting behavior changeUsual care and provision of information on disease
    Communication skills training, patient activation with attention to emotion, and discussion of behavior change
    Pill et al, 199840Practice based training in eliciting patient concerns and discussing behavior changeUsual care
    Communication skills training, patient activation with attention to emotion, and discussion of behavior change
    Smith et al, 199841Course of seminars, video and booklets on communication, and disease management skillsUsual care
    Communication skills training with attention to emotion, discussion of behavior change
    Peters et al, 199942Information leaflets and invitation to consult practice nurse who was trained to present information on disease, risk, and treatment and encourage women to ask questionsDisease information leaflet
    Patient activation and information about disease management
    Thom et al, 199943WorkshopUsual care
    Communication skills training with patient activation and attention to emotion
    Brown Betz et al, 199944WorkshopsUsual practice
    Communication skills training program with attention to emotion
    Interventions delivered both to the patient and to the practitioner
    Lewis et al, 199145Separate communication skills training sessions, videos and materials for patients and practitionersCourse on bicycle safety (patient) assessment of febrile child (practitioner)
    Child patient and parent activation and practitioner communication skills teaching, with attention to emotion
    Katon et al, 199546Videos and materials on cognitive-behavioral management of depression and encouraging question asking. Practitioner course on treatment of depression and case-based feedbackUsual care
    Patient activation, information about disease management and discussion of behavior change
    Rubenstein et al, 199547Patients completed functional status questionnaire preconsultation, practitioners taught questionnaire interpretationUsual care
    Patient activation, practitioner activated by patient questionnaire
    Joos et al, 199648Preconsultation, patient completes request for service form, practitioners taught communication skillsUsual care
    Patient activation, practitioner activated by patient questionnaire with attention to emotion, and communication skills training
    Hornberger et al, 199749Preconsultation, patient completes request for services form including emotional needsUsual care
    Patient activation, practitioner activated by patient questionnaire, with attention to emotion
    Wagner et al, 199750Preconsultation; patients completed functional status questionnaire in consultation, practitioners taught interpretationUsual care
    Patient activation, practitioner activated by patient questionnaire, with attention to emotion
    Maly et al, 199951Preconsultation; patient recorded two questions which were attached to the medical record, given medical notes and glossaryInformation sheet and patient suggestion list
    Patient activation, information about disease, and practitioner activated by patient note
    Reuben et al, 199952Specialist advice to practitioners via telephone; provision of information about disease and its treatment. Preconsultation booklet and telephone call to patientUsual care and nonstudy incentives
    Patient activation and information about disease management
    • View popup
    Table 3.

    Effects of Interventions on Patient Outcomes

    Author, YearObjective Health Outcomes (Disease Processes)*Subjective Health Outcomes (Illness Experience)Other OutcomesSatisfaction
    HbA1c = glycosylated hemoglobin; ++ = result significantly favors intervention group; + = result favors intervention group; – – = result significantly favors control group; – = result favors control group; 0∞ = outcome identical in both groups; cost = health services cost.
    Note: Principal outcome for each study in boldface; not analyzed = results not reported in original paper; missing = no data presented in the paper.
    * Physiology, survival, mortality.
    † No significant difference reported with no further data presented.
    Interventions delivered directly to patients
    Greenfield et al, 198522Pain: +Knowledge: – ––
    Functional status: ++ Cost: +
    Greenfield et al, 198814 HbA 1c : ++ Quality of life: ++Knowledge: +–
    Functional status: ++Cost: ++
    Kaplan et al, 198921 Blood pressure: ++ Functional status: ++Cost: missingMissing
    Well-being: missing
    Thompson et al, 1990a20 Anxiety: ++ Cost: +0∞
    Thompson et al, 1990b20 Anxiety: + Knowledge: checklist –++
    Message +
    Butow et al, 199423 Quality of life: 0∞ Knowledge: ––
    Street et al, 199524 Well-being: 0 † Knowledge: +
    McCann & Weinman, 199625Cost: – – +
    Davison & Degner, 199726 Anxiety: +
    Depression: +
    Kravitz et al, 199727 0 †
    Fleissig et al, 199928 ++
    Interventions delivered via practitioners
    Thomas, 197829 Symptom resolution: –
    Schulman & Swain, 198030 +
    Evans et al, 198731 Anxiety: ++ ++
    Thomas, 198732 Symptom resolution: ++
    Olsson et al, 198933 Symptom resolution: ++ Cost: not analyzed++
    Savage, 199039 Symptom resolution: – Cost: –– –
    Evans et al, 199235Cost: 0† ++
    Roter et al, 199513 Depression: ++ Cost: –
    Smith et al, 199536 ++
    Meland et al, 199737,38 Blood presure: + Quality of life: +Health behavior: exercise +– –
    Cholesterol: + Well-being: +Smoking 0†
    Thiocyanate:+ Functional status: +Cost: +
    Kinmonth et al, 199839 HbA 1c : + Quality of life: +Health behavior: diet 0†++
    Cholesterol: –Well-being: ++
    Triglyceride – –Exercise/smoking -
    Body mass index: – –Knowledge: – –
    Blood pressure: –
    Albumin/creatine: –
    Pill et al, 199840 HbA 1c : – Diabetic complication:+Health behavior: 0†– –
    Blood pressure: –Functional status: – –Cost: 0†
    Body mass index: –Well-being: 0†
    Smith et al, 199841 Depression: + Knowledge: missing+
    Functional status: +
    Peters et al, 199942Perceptions of health: –Health behavior: +
    Anxiety: + Cost: – –
    Functional status: +
    Thom et al, 199943 Health behavior: 0 † +
    Cost: 0†
    Brown Betz et al, 199944 –
    Interventions delivered both to the patient and to the practitioner
    Lewis et al, 199145 Anxiety: + Knowledge: ++++
    Katon et al, 199546 Depression: + Health behavior: ++++
    Functional status: missing
    Rubenstein et al, 199547 Functional status: ++
    Joos et al, 199648 Health behavior: medication – +
    Appointments: 0∞
    Hornberger et al, 199749Depression: +Cost: – –+
    Anxiety: ++
    Functional status: 0†
    Wagner et al, 199750Cost: – +
    Maly et al, 199951 Functional status: ++ Health behavior: +
    Cost: +
    Reuben et al, 199952 Mortality: + Functional status: +++

Additional Files

  • Figures
  • Tables
  • Supplemental Tables

    Table 2a. Effects of Interventions on Process of Consultations; Table 4. Summary of Relationships Between Intervention Categories and Health Outcomes

    Files in this Data Supplement:

    • Supplemental data: Table 2a - PDF file, 2 pages, 41 KB
    • Supplemental data: Table 4 - PDF file, 1 page, 66 KB
  • The Article in Brief

    Communication between doctors and patients is an important part of medical care. A limited amount of research has examined methods for changing the way that doctors and patients communicate in an office visit and how those methods affect patient health. A new study summarized this research and found that many approaches can influence communication between doctors and patients, and may improve patient health.

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Effect on Health-Related Outcomes of Interventions to Alter the Interaction Between Patients and Practitioners: A Systematic Review of Trials
Simon J. Griffin, Ann-Louise Kinmonth, Marijcke W. M. Veltman, Susan Gillard, Julie Grant, Moira Stewart
The Annals of Family Medicine Nov 2004, 2 (6) 595-608; DOI: 10.1370/afm.142

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Effect on Health-Related Outcomes of Interventions to Alter the Interaction Between Patients and Practitioners: A Systematic Review of Trials
Simon J. Griffin, Ann-Louise Kinmonth, Marijcke W. M. Veltman, Susan Gillard, Julie Grant, Moira Stewart
The Annals of Family Medicine Nov 2004, 2 (6) 595-608; DOI: 10.1370/afm.142
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