Effects of a self-administered previsit questionnaire to enhance awareness of patients' concerns in primary care.
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.


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


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


METHODS
Ten physicians and 201 continuity-care patients.


METHODS
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.


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.
Hornberger
J
J
Department of Health Research & Policy, Stanford University School of Medicine, CA 94305-90521, USA.
Thom
D
D
MaCurdy
T
T
D000328:Adult; D001294:Attitude to Health; D003142:Communication; D016001:Confidence Intervals; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011795:Surveys and Questionnaires; D014741:Video Recording