Reducing patients' unmet concerns in primary care: the difference one word can make.

摘要

CONTEXT: In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed. OBJECTIVE: To test an intervention to reduce patients' unmet concerns. DESIGN: Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys. SETTING: Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania. PARTICIPANTS: A volunteer sample of 20 family physicians (participation rate = 80%) and 224 patients approached consecutively within physicians (participation rate = 73%; approximately 11 participating for each enrolled physician) seeking care for an acute condition. INTERVENTION: After seeing 4 nonintervention patients, physicians were randomly assigned to solicit additional concerns by asking 1 of the following 2 questions after patients presented their chief concern: "Is there anything else you want to address in the visit today?" (ANY condition) and "Is there something else you want to address in the visit today?" (SOME condition). MAIN OUTCOME MEASURES: Patients' unmet concerns: concerns listed on previsit surveys but not addressed during visits, visit time, unanticipated concerns: concerns that were addressed during the visit but not listed on previsit surveys. RESULTS: Relative to nonintervention cases, the implemented SOME intervention eliminated 78% of unmet concerns (odds ratio (OR) = .154, p = .001). The ANY intervention could not be significantly distinguished from the control condition (p = .122). Neither intervention affected visit length, or patients'; expression of unanticipated concerns not listed in previsit surveys. CONCLUSIONS: Patients' unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form. Both the learning and implementation of the intervention require very little time.