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Impact of patient requests on provider-perceived visit difficulty in primary care
- Source :
- Journal of general internal medicine, vol 30, iss 2
- Publication Year :
- 2015
- Publisher :
- eScholarship, University of California, 2015.
-
Abstract
- Background"Difficult visits" are common in primary care and may contribute to primary care provider (PCP) career dissatisfaction and burnout. Patient requests occur in approximately half of primary care visits and may be a source of clinician-patient miscommunication or conflict, contributing to perceived visit difficulty.ObjectiveWe aimed to determine associations between types of patient requests and PCP-perceived visit difficulty.DesignThis was an observational study, nested in a multicenter randomized trial of depression engagement interventions.SubjectsWe included 824 patient visits within 135 PCP practices in Northern California occurring from June 2010 to March 2012.Main measuresPCP-perceived visit difficulty was quantified using a three-item scale (relative visit difficulty, amount of effort required, and amount of time required; Cronbach's α = 0.81). Using linear regression, the difficulty scale (score range 0-2 from least to most difficult) was modeled as a function of: patient requests for diagnostics tests, pain medications, and specialist referrals; PCP perception of likely depression or likely substance abuse; patient sociodemographics, comorbidity, depression; PCP characteristics and practice setting.ResultsPatients requested diagnostic tests, pain medications, and specialist referrals in 37.2, 20.0 and 30.0% of visits, respectively. After adjustment for patient medical and psychiatric complexity, perceived difficulty was significantly higher when patients requested diagnostic tests [parameter estimate (PE) 0.11, (95% CI: 0.03, 0.20)] but not when patients requested pain medications [PE -0.04 (95% CI: -0.15, 0.08)] or referrals [PE 0.04 (95% CI: -0.07, 0.25)].ConclusionsPCP-perceived visit difficulty is associated with patient requests for diagnostic tests, but not requests for pain medications or specialist referrals. In this era of "choosing wisely," PCPs may be challenged to respond to diagnostic test requests in an evidence-based manner, while maintaining the provider-patient relationship and PCP career satisfaction.
- Subjects :
- Adult
Male
medicine.medical_specialty
patient satisfaction
Attitude of Health Personnel
Office Visits
education
Clinical Sciences
Primary health care
Primary care
Burnout
primary care
Patient satisfaction
Diagnostic Tests
Clinical Research
General & Internal Medicine
Health care
Internal Medicine
medicine
Humans
Routine
patient communication
Depression (differential diagnoses)
Original Research
Physician-Patient Relations
Primary Health Care
business.industry
Diagnostic Tests, Routine
Depression
Pain Research
Neurosciences
Middle Aged
Health Services
medicine.disease
Comorbidity
comorbidity
Mental Health
Good Health and Well Being
Patient Satisfaction
Family medicine
Patient communication
Female
Chronic Pain
business
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Journal of general internal medicine, vol 30, iss 2
- Accession number :
- edsair.doi.dedup.....16cf8f3e0ec5ddb2688168dacd115a46