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

<bold>Context: </bold>In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed.<bold>Objective: </bold>To test an intervention to reduce patients' unmet concerns.<bold>Design: </bold>Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys.<bold>Setting: </bold>Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania.<bold>Participants: </bold>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.<bold>Intervention: </bold>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).<bold>Main Outcome Measures: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]