Fielding standardized patients in primary care settings: lessons from a study using unannounced standardized patients to assess preventive care practices.
OBJECTIVE
To document detection and suspicion rates of unannounced standardized patients visiting community-based practices.


METHODS
Primary care physicians were recruited to participate in a study using standardized patients. Four standardized patient scenarios were used.


METHODS
Community-based primary care physicians' practices in southern Ontario between September 1994 and August 1995.


METHODS
Sixty-two primary care physicians.


METHODS
A 'believability' questionnaire completed after all four standardized patients had visited the practices.


RESULTS
Of the primary care physicians approached, 50% (62) agreed to participate. Twenty-one per cent of all visits were suspected as standardized patient encounters. Forty-six per cent suspected one or more standardized patients. Only five physicians (8%) suspected all four standardized patients. Reasons for suspecting standardized patients were associated with the characteristics of the physician's practices, the physician's practice profile and the standardized patient cover story.


CONCLUSIONS
The portrayal of asymptomatic patients seeking a new primary care physician presents unique challenges. Carefully constructed cover stories, and detailed knowledge of the local area and of the practices of the participating physicians is required to allow standardized patients cases to be tailored to fit into primary care settings without arousing suspicion.
Brown
J A
JA
Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario, Canada.
Abelson
J
J
Woodward
C A
CA
Hutchison
B
B
Norman
G
G
D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D009864:Ontario; D010361:Patients; D010818:Practice Patterns, Physicians' / Q000592:standards; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D012381:Role Playing; D011795:Surveys and Questionnaires