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Effects of a self-administered previsit questionnaire to enhance awareness of patient’s concerns in primary care

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Abstract

Objective

To determine if a self-administered previsit questionnaire designed to increase awareness of patients’ concerns alters the visit duration, content of the discussion, and patient and physician satisfaction.

Design

A balanced, two-arm trial in which physicians were randomized.

Setting

Two primary-care clinics affiliated, with a university hospital.

Patients/Participants

Ten physicians and 201 continuitycare patients.

Interventions

In intervention visits, patients completed a previsit questionnaire asking about the desire for medical information, psychosocial assistance, therapeutic listening, general health advice, and biomedical treatment. Physicians reviewed questionnaires with patients during the visit.

Measurements and main results

We used audiotapes of encounters to quantify the duration of the encounter and measured the number and type of diagnoses discussed in the visit, and patient and physician satisfaction with the encounter. Intervention visits were 34% longer (increase of 6.8 minutes; 95% confidence interval, [CI] 0.4, 13.2) than control visits with most of the additional time spent in discussion of biomedical diagnoses (3.35 minutes; 95% CI 0.00, 6.72) and in the performance of the physical examination (2.7 minutes; 95% CI 0.5 4.9). The number of diagnoses discussed per visit was 30% higher in intervention visits (increase of 1.7 diagnoses per visit; 95% CI 0.3, 3.2), but patients’ satisfaction with these visits tended to be lower.

Conclusions

Using a previsit questionnaire to increase awareness of the patients’ concerns may entail a trade-off between conflicting goals: trying to respond to patient concerns while not significantly increasing the cost per visit. A future challenge is to develop and refine techniques with sufficient efficacy to justify the expense of implementing the intervention and the longer visit needed to respond adequately to patients’ concerns.

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Author information

Authors and Affiliations

  1. Department of Health Research & Policy, Stanford University School of Medicine, HRP Redwood Building. Rm T254A, 94305-90521, Stanford, CA

    John Hornberger MD, MS & David Thom MD, PhD

  2. Department of Medicine, Stanford University School of Medicine, 94305-90521, Stanford, Calif

    John Hornberger MD, MS & David Thom MD, PhD

  3. Department of Economics, Stanford University, Calif

    Thomas MaCurdy PhD

Authors
  1. John Hornberger MD, MS
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  2. David Thom MD, PhD
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  3. Thomas MaCurdy PhD
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Additional information

Dr. Hornberger and Dr. Thom are Picker/Commonwealth Scholars. This study was supported by the Picker Institute, the Association for Health Services Research, and the Good Samaritan Foundation.

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Hornberger, J., Thom, D. & MaCurdy, T. Effects of a self-administered previsit questionnaire to enhance awareness of patient’s concerns in primary care. J GEN INTERN MED 12, 597–606 (1997). https://doi.org/10.1046/j.1525-1497.1997.07119.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1997.07119.x

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