Abstract
Objectives
To know the patients’ expectations and the fulfillment of these at family medicine consultations by resident doctors and to assess their effect on some consultation outcomes.
Design
A prospective cohort study.
Participants
Patients attending family medicine consultations held by 38 resident doctors: 1,301 eligible patients, 702 filled in all questionnaires.
Measurements
Before each visit, the patients’ expectations about that particular consultation were registered. Right after the visit was over, their perception of several aspects of the communicative interaction with the doctor was measured. Later, patients were interviewed on the phone to know how their expectations had been fulfilled, how satisfied they were about the consultation, how they had followed the doctor’s suggestions, if they were going to seek further care for the same cause later, and the evolution of their clinical problem. Logistic regression was the main analysis used.
Results
The most common expectations were the doctor showing interest and listening (30.5%), getting some information about the diagnosis (16.3%), and sharing problems and doubts (11.1%). The rate of main expectations that were met was 76.5%. Satisfaction with the encounter was associated with the clinical evolution [odds ratio (OR) 2.23; confidence interval (CI): 1.32–3.75], and the fulfilling of the patients’ main or two main expectations was significantly related to all the measured outcomes (satisfaction OR 3.51, CI: 1.73–7.8; adherence OR 1.80, CI: 1.11–2.92; clinical evolution OR 1.54, CI: 1.01–2.35; and seeking further care later OR 0.54, CI:0.36–0.81)
Conclusions
Patients prioritize expectations of a more general sort when they attend primary care consultations and residents fulfill these acceptably. The fulfillment of expectations seems to affect the studied outcomes more than other factors.
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References
Kravitz R. Measuring patients’ expectations and requests. Ann Intern Med. 2001;134:881–8.
Williams S, Weinman J, Dale J, Newman S. Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Fam Pract. 1995;12:193–201.
Kravitz R, Callahan E, Paterniti D, Antonius D, Dunham M, Lewis C. Prevalence and sources of patients’ unmet expectations for care. Ann Intern Med. 1996;125:730–7.
Hamm R, Hicks R, Bemben D. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996;43:56–62.
Marple R, Kroenke K, CR L, Wilder J, Lucas C. Concerns and expectations in patients presenting physical complaints. Arch Intern Med. 1997;157:1482–8.
Peck B, Ubel P, Roter D, et al. Do unmet expectations for specific tests, referrals and new medications reduce patients’ satisfaction? J Gen Intern Med. 2004;19:1080–7.
Kravitz R, Cope D, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visit. J Gen Intern Med. 1994;9:75–81
Kravitz R, Callahan E, Azari R, Antonius D, Lewis C. Assessing patients’ expectations in ambulatory medical practice. Does measurement approach make a difference? J Gen Intern Med. 1997;12:67–72.
Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unsaid but not forgotten. Arch Intern Med. 2001;161:1977–84.
Jackson J, Kroenke K. The effect of unmet expectations among adults presenting physical symptoms. Ann Intern Med. 2001;134:889–97.
Thom D, Kravitz R, Bell R, Krupat E, Azari R. Patients trust in the physician relationship to patient requests. Fam Pract. 2002;19:476–83.
Rao J, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes. A literature review. Arch Fam Med. 2000;9:1148–55.
Peltenburg M, Fischer J, Bahrs O, van Dulmen S, van den Brink-Muinen A. The unexpected in primary care: A multicentered study on the emergence of unvoiced patient agenda. Ann Fam Med. 2004;2:534–40.
Peck B, Asch D, Goold S, et al. Measuring patient expectations. Does the instrument affect satisfaction or expectations? Med Care. 2001;39:100–8.
Zebiene E, Razgauskas E, Basys V, et al. Meeting patient’s expectations in primary care consultation in Lithuania. Int J Qual Health Care. 2004;16:83–9.
Froehlich G, Weich G. Meeting walk-in patients’ expectations for testing. J Gen Intern Med. 1996;11:470–4.
Himmel W, Lippert-Urbanke E, Kochen M. Are patients more satisfied when they receive a prescription? The effect of expectations in general practice. Scand J Prim Health Care. 1997;15:118–22.
Uhlmann R, Inui T, Pecorato R, Carter W. Relationship to patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependence diabetes. J Gen Intern Med. 1988;3:458–63.
Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unmet expectations for care and the patient–physician relationship. J Gen Intern Med. 2002;17:817–24.
Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315:1211–4.
Jackson J, Kroenke K, Chamberlin J. Effects of physician awareness of symptom-related expectations and mental disorders. Arch Fam Med. 1999;8:135–42.
Kravitz R, Bell R, Azari R, Krupat E, Kelly-Reif S, Thom D. Request fulfillment in office practice: antecedents and relationship to outcomes. J Gen Intern Med. 2002;40:38–51.
Kaplan S, Greenfield S, Ware J. Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S111–127.
Kinmonth A, Woodcock A, Griffin S, Spiegal N, Campbell M, on behalf of the Diabetes Care from Diagnosis Research Team. Randomised controlled trial of patient centred care of diabetes in general practice: impact on current well-being and future disease risk. BMJ. 1998;317:1202–8.
Sanchez-Menegay C, Hudes E, Cummings S. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432–4.
Junod Perron N, Secretan F, Vannotti M, Pecoud A, Favrat B. Patient expectations at a multicultural out-patient clinic in Switzerland. Fam Pract. 2003;20:428–33.
Sánchez-Menegay C, Stalder H. Do physicians take into account patients’ expectations? J Gen Intern Med. 1994;9:404–6.
Cabré Vila J, Ortega Vila Y, Vila Córcoles A, Guillén López A, Checa Webber E, Farré Guasch J. ¿Qué espera el paciente de su médico de familia cuando acude habitualmente a su consulta? (What do patients expect from their family doctors when they go to their consultation on a regular basis?) Aten Primaria 1999;24:403–4.
Palacio Lapuente F, Marquet Palomer R, Oliver Esteve A, Castro Guardiola P, Bel Reverter M, Piñol Moreso J. Las expectativas de los pacientes: ¿qué aspectos valoran en un centro de salud? Un estudio cualicuantitativo. (Patients’ expectations: what aspects do they value in a health centre? A quali-quantitative study). Aten Primaria 2003;31:307–14.
Deveugele M, Derese A, van der Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross-sectional study in six European countries. BMJ. 2002;325:472–7.
Seguí Díaz M, Linares Pou L, Blanco López W, Ramos Aleixades J, Torrent Quetglás M. Tiempos durante la visita médica en atención primaria.(Length of medical visits in primary care) Aten Primaria 2004;33:496–502.
Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Evolución del perfil comunicacional de los médicos residentes de medicina de familia. (Evolution of the communicative profile of family medicine trainees) Aten Primaria 2002;29:132–44.
Ruiz Moral R, Parras Rejano J, Alcalá Partera J, Castro Marín E, Pérula de Torres L. ¿Bienvenido y hasta luego u hola y adiós?: conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas. (Welcome and so long or hello and goodbye? Communicative behaviours of resident doctors at the beginning and end of consultations). Aten Primaria 2005;36:537–44.
Ruiz-Moral R, Perez Rodriguez E, Perula de Torres L, Torre de la Torre J. Physician–patient communication: a study on the observed behaviours of specialty physicians and the ways their patients perceive them. Patient Educ Couns 2006 doi:10.1016/j.pec.2006.02.010 (in press).
Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Effectiveness of a clinical interviewing training program for family practice residents: a randomized controlled trial. Fam Med. 2003;35:489–95.
Levy-Storms L, Schnelle J, Simmons S. A comparison of methods to assess nursing home residents’ unmet needs. Gerontologist. 2002;42:454–61.
Levy-Storms L, Simmons S, Gutierrez V, Miller-Martínez D, Hickey K, Schnelle J. A refined protocol for coding nursing home residents’ comments during satisfaction interviews. J Gerontol B Psychol Sci Soc Sci. 2005;60:S326–330.
Webb S, Lloyd M. Prescribing and referral in general practice: a study of patients’ expectations and doctors’ actions. Br J Gen Pract. 1994;44:165–9.
Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations—a questionnaire study. BMJ. 1997;315:520–3.
Stewart M, Brown J, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.
Little P, Everitt H, Williamson I, et al. Observational study on the effect of patient centeredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908–11.
Acknowledgements
We thank Ronald Epstein (University of Rochester) for his helpful suggestions about the manuscript and Purificación Jiménez for her assistance with the English version. A part of this study (“Patient expectations with general practice visit and their relationship with visit outcomes”) was presented at the European Association of Communication & Health conference in Brugge (Belgium) in September, 2004.
Potential Financial Conflicts of Interest
None disclosed.
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This work has been funded by a grant from the Andalusian Health Service (Health Council of the Andalusian Autonomous Government) (exp 187/00) and Andalusian Society of Family and Community Medicine (SAMFYC).
Appendices
Appendix
SPPIC (scale on the patient’s perception of the interaction at the consultation)
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Ruiz-Moral, R., Pérula de Torres, L. & Jaramillo-Martin, I. The Effect of Patients’ Met Expectations on Consultation Outcomes. A Study with Family Medicine Residents. J GEN INTERN MED 22, 86–91 (2007). https://doi.org/10.1007/s11606-007-0113-8
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DOI: https://doi.org/10.1007/s11606-007-0113-8