Patients’ Question-Asking Behavior During Primary Care Visits: A Report From the AAFP National Research Network

James M. Galliher; Douglas M. Post; Barry D. Weiss; L. Miriam Dickinson; Brian K. Manning; Elizabeth W. Staton; Judith Belle Brown; John M. Hickner; Aaron J. Bonham; Bridget L. Ryan; Wilson D. Pace

doi:10.1370/afm.1055

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Figure 1.
Recruitment of practices and patients into the trial assessing the effects of the Ask Me 3 patient intervention.
AAFP NRN = American Academy of Family Physicians National Research Network; FU = follow-up.

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Table 1.

Data Collection: Sources and Timing

Source	Timing of Collection	No. (%) of Enrolled Patients With Usable Data (n=834)
^a Of 524 patients eligible for follow-up. Patients were eligible for a follow-up telephone interview if their study physician stated in the postvisit questionnaire that a prescription (new, refill, both) had been written at the office visit.
Patient postvisit questionnaires	Immediately after visit	829 (99)
Physician postvisit questionnaires	Immediately after visit	829 (99)
Audio recordings	During visit	763 (92)
Patient follow-up telephone interviews	About 2 weeks after visit	455 (87)^a

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Table 2.

Selected Questions Asked of Patients During the Follow-up Telephone Interview

^a Response options were Yes, No, and Don’t remember.

^b Response options were All of them, Some of them, and None of them.

Did [name of study physician] write/give you any new prescriptions at that visit?^a
Have you had these new prescriptions filled at a pharmacy?^a
Did [name of study physician] write you any refill prescriptions for medicine you were taking before this doctor’s visit?^a
Have you had these prescriptions filled at a pharmacy?^a
How many of the medications (new and old) that were pre-scribed to you at the visit are you taking?^b

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Table 3.

Patients’ Characteristics as Obtained From the Postvisit Questionnaire, for Intervention Practices (n = 445 Patients) and Control Practices (n = 389 Patients)

Characteristic	Intervention Patients % or Mean	Control Patients % or Mean	P Value
^a χ² test.
^b Student t test for independent samples.
Sex (n)	(443)	(386)	.06^a
Male	68	62
Female	32	38
Age category (n)	(435)	(382)	.09^a
18–30 y	14	10
31–40 y	15	12
41–50 y	19	25
51–60 y	19	24
61–70 y	19	17
71–80 y	14	12
Racial identification (n)	(431)	(378)	.60^a
White	85	83
Black	10	12
Other/≥2 responses	4	5
Ethnic identification (n)	(431)	(378)	.002^a
Hispanic	10	4
Not Hispanic	90	96
Current marital status (n)	(434)	(383)	.048^a
Married	64	54
Living together	4	6
Separated	4	3
Divorced	10	14
Widowed	9	12
Never married	10	12
Employed full-time (n)	(434)	(383)	.21^a
Yes	44	40
No	56	60
Employed part-time (n)	(443)	(386)	.63^a
Yes	13	14
No	87	86
Retired (n)	(443)	(386)	.05^a
Yes	26	20
No	74	80
Educational attainment (n)	(432)	(384)	.02^a
<High school	11	16
High school graduate	33	28
Some college	30	27
College graduate	19	16
Postgraduate study	8	13
Years as patient of study physician (n)	3.07 (281)	3.37 (221)	.07^b
Source of insurance (n)	(433)	(380)	.07^a
Private	50	47
Medicare	31	27
Medicaid	6	8
Self-pay	8	13
Other	5	6

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Table 4.

Patients’ Health Literacy as Obtained From the Postvisit Questionnaire, for Intervention Practices (n = 445 Patients) and Control Practices (n = 389 Patients)

Health Literacy Question	Intervention Patients, %	Control Patients, %	P Value
^a χ² test.
How often does someone help you read things your doctor gives you? (n)	(436)	(373)	.15^a
Always/often	11	15
Sometimes	28	25
Never	62	60
How easy or hard is it to fill out medical forms by yourself? (n)	(435)	(370)	.001^a
Extremely/very hard	3	8
Somewhat hard/easy	27	29
Extremely/very easy	70	62
How often is it hard to understand written information about your medical problems? (n)	(436)	(372)	.65^a
Always/often	7	9
Sometimes	54	55
Never	39	36

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Table 5.

Question-Asking Behavior by Patients in Intervention Practices (n = 415 Patients) and Control Practices (n = 352 Patients) as Determined From Audio Recordings

	Unadjusted			Adjusted^a,b
Measure	Intervention Patients % or Mean	Control Patients % or Mean	P Value	Intervention Patients % or Mean	Control Patients % or Mean	P Value
AM3=Ask Me 3.
^a F statistic from generalized linear mixed models (for categorical data) or general linear mixed models (for continuous data).
^b Adjusted for clustering and the following covariates: age, sex, race/ethnicity (non-Hispanic white vs other/missing), education, years with physician.
^c χ² test.
^d Student t test for independent samples.
Did patient ask any AM3 questions? (% Yes)	26	30	.16^c	26	31	.34
Did patient ask any questions of any type? (% Yes)	92	92	.87^c	92	91	.84
Number of AM3 questions	0.47	0.52	.56^d	0.50	0.53	.83
Number of questions including AM3	6.94	6.37	.23^d	6.75	6.55	.82
Number of questions excluding AM3	6.46	5.86	.18^d	6.23	6.03	.80

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Table 6.

Unadjusted and Adjusted Patient Outcomes as Obtained From the Follow-up Telephone Interviews, for Intervention Practices (n = 415 Patients) and Control Practices (n = 352 Patients)

	Unadjusted			Adjusted^a,b
Outcome	Intervention Patients % or Mean	Control Patients % or Mean	χ² Test P Value	Intervention Patients % or Mean	Control Patients % or Mean	P Value
^a F statistic from generalized linear mixed model.
^b Adjusted for clustering and the following covariates: age, sex, race/ethnicity (non-Hispanic white vs other/missing), education, years with physician.
^c Patients’ self-reports of filling prescription among those reporting having received a prescription at the visit. Some of these patients’ physicians stated that they did not write a prescription at the visit.
^d Patients’ self-reports of taking the medications prescribed at the visit among those who reported receiving a new prescription, a refill prescription, or both.
^e Patients’ self-reports of attempting lifestyle changes among those who reported that their physician recommended a lifestyle change at the visit. Some of these patients’ physicians stated that they did not recommend a lifestyle change at the visit.
Accurately recalled any prescription (n)	(247)	(206)	.45			.41
Yes	92	90		92.9	90.8
No	8	10
Accurately recalled new prescription (n)	(182)	(127)	.40			.54
Yes	74	69		74.2	70.4
No	26	31
Accurately recalled refill prescription (n)	(101)	(123)	.67			.68
Yes	81	79		81.0	78.2
No	19	21
Filled new prescription^c (n)	(143)	(104)	.75			.82
Yes	81	83		81.1	82.4
No	19	17
Filled refill prescription^c (n)	(113)	(123)	.99			.71
Yes	70	70		68.6	71.0
No	30	30
Was taking =1 prescription^d (n)	(205)	(170)	.91			.96
Yes	90	91		90.3	90.5
No	10	9
Accurately recalled lifestyle recommendations (n)	(242)	(206)	.04			.14
Yes	59	68		59.3	68.4
No	41	32
Attempted lifestyle change^e (n)	(95)	(102)	.90			.78
Yes	93	92		93.3	92.3
No	7	8

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The Article in Brief

Patient Question-Asking Behavior During Primary Care Visits: A Report From the AAFP National Research Network

James M. Galliher , and colleagues

Background The Ask Me 3 health communication program encourages patients to ask specific questions during office visits in order to improve understanding of their health conditions and adherence to treatment recommendations. This study evaluates whether Ask Me 3 improves patients� question-asking behavior and increases adherence to prescription medications and lifestyle recommendations.

What This Study Found In this study, the Ask Me 3 program showed no effect on either questioning by patients or adherence to advice. The authors suggest this finding may be because participating patients already asked questions at high rates and had fairly high levels of adherence to treatment recommendations.

Implications

Further study of Ask Me 3 may be useful in practices with lower rates of question-asking and adherence to treatment.