title: An exploration of patient and family engagement in routine primary care visits.
abstract: BACKGROUND
  Older adults are commonly accompanied to routine medical visits. Whether and how family companion behaviours relate to visit processes is poorly understood.
  
  
  OBJECTIVE
  To examine family companion behaviours in relation to older adults' medical visit processes.
  
  
  METHODS
  Observational study of 78 accompanied primary care patients ages 65 and older.
  
  
  METHODS
  Medical visit communication (coded using RIAS), patient verbal activity (as a proportion of visit statements) and visit duration (in min), from audio recordings.
  
  
  RESULTS
  Companions' facilitation of patient involvement was associated with greater patient question asking (P = 0.017) and orienting statements, less passive agreement (P = 0.004) and social talk (P = 0.013) and visits that were 3.4 min longer (P = 0.025). Facilitation of patient understanding was associated with less physician question asking (P = 0.004), visits that were 3.0 min longer (P = 0.031), and lower patient verbal activity (30.3% vs. 36.9% of visit statements; P = 0.028). Facilitation of doctor understanding was associated with greater patient biomedical information giving (P = 0.049). Autonomy detracting behaviours were not associated with visit duration but were associated with lower levels of patient verbal activity (36.3% vs. 29.1% of visit statements; P = 0.041). When companions assumed more behaviours, medical visits were incrementally longer (16.1, 19.5, 21.7 min, corresponding to 0-1, 2-4 and 5+ behaviours; P < 0.001 both contrasts), and patients were less verbally active (35.6%, 33.9%, 27.1% of visit statements; P = 0.09 and P = 0.009, respectively).
  
  
  CONCLUSIONS
  Behaviours assumed by patients' companions were associated with visit communication, patient verbal activity and visit duration.
  
  
  CONCLUSIONS
  Interventions to capitalize on family companions' presence may benefit medical visit processes.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Marla L
authors.initials: ML
authors.lastname: Clayman
authors.forename: Peter
authors.initials: P
authors.lastname: Rabins
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Cook
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001519:Behavior; D003142:Communication; D005190:Family; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D009819:Office Visits; D010358:Patient Participation / Q000379:methods*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: RIAS; doctor-patient-companion communication; patient-provider communication; triadic communication