title: Effects of improved patient participation in primary care on health-related outcomes: a systematic review.
abstract: BACKGROUND
  In primary care, many consultations address symptom-based complaints. Recovery from these complaints seldom exceeds placebo effects. Patient participation, because of its supposed effects on trust and patient expectancies, is assumed to benefit patients' recovery. While the idea is theoretically promising, it is still unclear what the effects of increased patient participation are on patient outcomes. Aim. To review the effects of controlled intervention studies aiming to improve patient participation in face-to-face primary care consultations on patient-oriented and/or disease-oriented outcomes.
  
  
  METHODS
  This study is a systematic review. A systematic search was undertaken for randomized controlled trials designed to measure the effects of interventions that aimed to improve adult patients' participation in primary care visits. The CINAHL, Cochrane, EMBASE, PsycINFO and PubMed databases were searched.
  
  
  RESULTS
  Seven different trials fulfilled the inclusion criteria. Three of the studies were related to symptom-based complaints. Five studies measured patient-oriented outcomes, the primary outcome of interest for this review. All studies suffered from substantial bias. Studies varied widely in their aims, types of complaints/diseases, strength of the interventions and their outcomes. The effects on patient-oriented outcomes and disease-oriented outcomes were ambiguous.
  
  
  CONCLUSIONS
  Little research has been performed on health outcomes of interventions aiming to increase patient participation in general practice visits among patients suffering from symptom-based complaints. The results still are non-conclusive. The quality of the trials has been weak, possibly due to the complexity of the concept. This weak quality may explain the lack of conclusive results. Proposals for future research designs are offered.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht. the Netherlands. a.r.j.sanders-vanlennep@umcutrecht.nl
authors: Ariëtte R J
authors: AR
authors: Sanders
authors: Inge
authors: I
authors: van Weeghel
authors: Maartje
authors: M
authors: Vogelaar
authors: William
authors: W
authors: Verheul
authors: Ron H M
authors: RH
authors: Pieters
authors: Niek J
authors: NJ
authors: de Wit
authors: Jozien M
authors: JM
authors: Bensing
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003657:Decision Making; D006801:Humans; D063868:Patient Outcome Assessment; D010358:Patient Participation / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D016032:Randomized Controlled Trials as Topic; D063189:Symptom Assessment; D016896:Treatment Outcome
keywords: Patient participation; patient-oriented outcomes; primary health care; review (publication type).; shared decision-making
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