RT Journal Article
SR Electronic
T1 The Unexpected in Primary Care: A Multicenter Study on the Emergence of Unvoiced Patient Agenda
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 534
OP 540
DO 10.1370/afm.241
VO 2
IS 6
A1 Michael Peltenburg
A1 Joachim E. Fischer
A1 Ottomar Bahrs
A1 Sandra van Dulmen
A1 Atie van den Brink-Muinen
A1 for the investigators of the Euro-Communication Study
YR 2004
UL http://www.annfammed.org/content/2/6/534.abstract
AB PURPOSE Within the time constraints of a typical physician-patient encounter, the full patient agenda will rarely be voiced. Unexpectedly revealed issues that were neither on the patient’s list of items for discussion nor anticipated by the physician constitute an emerging agenda. We aimed to quantify the occurrence rate of emerging agendas in primary care practices and to explain the variation between patients and practices. METHODS This observational cross-sectional study involved 182 primary care practices in 9 European cultural regions. Consecutive primary care consultations were videotaped and rated. Patients completed preconsultation and postconsultation questionnaires assessing their expectations and perceived care. Emerging agenda, determined by using 11-item preconsultation and postconsultation questionnaires, was defined as care perceived by the patient to be in addition to expected care, after adjustment for cultural variations of patient expectations. RESULTS For consultations involving 2,243 patients (mean age, 44.8 years, 58.4% women), every sixth (15.8%) consultation revealed emerging psychosocial agenda. Biomedical agenda emerged in14.5% of the consultations. Rates for unmet expectations were 13.6% and 10.3%, respectively, for psychosocial and biomedical problems. Practices showed considerable heterogeneity of occurrence of emerging agenda (biomedical, median 13%, range 0%–67%; psychosocial, median 14%, range 0%–53%). After controlling for region and patient baseline characteristics, variables significantly related to emerging agenda were patient expectations and biomedical or psychosocial discourse content, but not consultation time or sex of the patient. A large proportion of the variance attributable to physicians remained concealed in a practice dummy variable (explaining up to 8% of the variance). CONCLUSION Unexpected agenda emerges in every sixth to seventh consultation in outpatient primary care visits.