title: Impact of a simple intervention to increase primary care provider recognition of patient referral concerns.
abstract: OBJECTIVE
  To determine whether a brief previsit questionnaire about referral concerns can improve primary care provider (PCP) recognition of patient concerns and satisfaction with care.
  
  
  METHODS
  Sequential prospective study in the internal medicine clinic of an academic medical center providing primary care to patients enrolled in a gatekeeper-model managed care plan.
  
  
  METHODS
  Twelve faculty internists serving as PCPs for 1495 consecutive patient visits. Patients were given a previsit questionnaire asking about referral need and rationale and a postvisit questionnaire asking about discussion of referral concern and visit satisfaction. Providers were given a postvisit questionnaire asking whether a referral was discussed and made and about visit satisfaction. In the control phase, patient previsit questionnaires remained confidential, whereas in the intervention phase PCPs were shown the previsit questionnaires at the time of encounter.
  
  
  RESULTS
  The intervention significantly increased PCP referral recognition from 61% to 81% (P < .001) and was associated with increased visit satisfaction (P = .05). Satisfaction of PCPs with the referral discussion, overall rate of referral, and visit duration were not affected by the intervention.
  
  
  CONCLUSIONS
  Using a brief previsit questionnaire about patient referral concerns increases PCP recognition of such concerns. The intervention does not adversely affect PCP satisfaction with the referral discussion or the overall referral rate and may enhance patient visit satisfaction.
authors.affiliation: Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver 80262, USA. gail.albertson@uchsc.edu
authors.forename: Gail
authors.initials: G
authors.lastname: Albertson
authors.forename: C T
authors.initials: CT
authors.lastname: Lin
authors.forename: Lisa
authors.initials: L
authors.lastname: Schilling
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cyran
authors.forename: Susan
authors.initials: S
authors.lastname: Anderson
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Anderson
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D005260:Female; D020793:Gatekeeping; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D020380:Needs Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States