Style B 36 by 48 wide

1
Physician Patient Perceptions of
Physician Knowledge about Patient Information
during Primary Care Visits Paul Smith2, Molly
Snellman3, Brian Arndt2, John Beasley2, Roger
Brown4, Mary Ellen Hagenauer6, Kate Judge2, Jamie
Stone5,6, Bentzi Karsh6, Tosha Wetterneck1
1Department of Medicine, 2Department of Family
Medicine University of Wisconsin (UW) School of
Medicine and Public Health 3UW Medical
Foundation 4School of Nursing, 5School of
Pharmacy, 6Department of Industrial and Systems
Engineering, UW-Madison, WI
Introduction
Methods

• Study design
• Randomized controlled trial of a pre-visit
  planning intervention
• Pre-data collection April December 2011
• Setting Participants
• 4 Primary care clinics in Southwest/Central WI
• 16 primary care physicians, 4 per clinic
• 48 - 50 patients age 65 or older per physician

• Patient info availability during elderly primary
  care visits is a safety issue
• Scant primary care research on patient
  physician perceptions of safety of care
  congruency of perceptions
• Knowledge of discrepancies is useful to improve
  the safety and patient centeredness

• Survey questionnaire
• Post-visit survey for doctors patients
• 8 Qs how much patient info was available for
  visit
• Example
• P Did this doctor have all the information he or
  she needed for the visit?
• D Was there information missing from todays
  visit?
• Question scale 1None, 2 A little,
  3 Some, 4 Moderately, 5 Pretty Much, 6
  Very Much, 7 Completely

• Analysis
• Responses grouped into 3 info availability
  categories 1-2 (low), 3-5 (medium), 6-7 (high)
• Descriptive statistics used to calculate
  response in each category for physicians
  patients and congruency of response category for
  each visit
• Chi-square used to compare response congruency
  btw physicians patients for each visit

Patient Characteristics
Research Goal

• Determine congruency of perceptions btw
  physicians elderly patients of physician
  knowledge of patient information during a primary
  care visit.

Patients 755
Mean age, years 76
Female () 63
w/ Chronic health conditions 91 1, 61 gt 2
Results
Conclusions
Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses Table 1 Congruency Between Patient and Doctor Responses
(PPatient, DDoctor) (PPatient, DDoctor)   of Responses in Each Category of Responses in Each Category of Responses in Each Category P D Ideal State P gt D P lt D  
Question n (visits)   1-2 3-5 6-7 Same Score P D 6,7 Patient Score Higher Patient Score Lower P value
Knowledge about ongoing medical problems 700 P 2 13 85 57 53 34 8 0.000
Knowledge about ongoing medical problems 700 D 5 34 61 57 53 34 8 0.000
2. Have all the information needed 704 P 0 12 88 70 66 23 8 0.000
2. Have all the information needed 704 D 3 24 73 70 66 23 8 0.000
3. Knowledge about visits to other health professionals 638 P 3 18 80 72 68 13 15 0.000
3. Knowledge about visits to other health professionals 638 D 3 15 82 72 68 13 15 0.000
4. Knowledge about results of tests and procedures 681 P 2 11 87 76 74 15 10 0.000
4. Knowledge about results of tests and procedures 681 D 3 14 83 76 74 15 10 0.000
5. Knowledge about medications 705 P 1 7 92 77 76 16 7 0.001
5. Knowledge about medications 705 D 3 15 83 77 76 16 7 0.001
6. Knowledge about care and medication cost concerns 563 P 5 17 78 67 65 14 19 0.001
6. Knowledge about care and medication cost concerns 563 D 2 16 83 67 65 14 19 0.001
7. Knowledge about health concerns 700 P 1 10 89 52 48 42 6 0.000
7. Knowledge about health concerns 700 D 8 38 54 52 48 42 6 0.000
8. Knowledge about main reason for visit 705 P 1 7 93 65 63 32 4 0.000
8. Knowledge about main reason for visit 705 D 5 29 66 65 63 32 4 0.000

• For over 1/3 of visits, doctors did not have good
  info on main reason for visit, health concerns,
  ongoing medical problems
• Doctors patients agreed about info availability
  48-76 of time
• Least health concerns
• Most tests/procedures
• Patients thought their doctor had more
  information than their doctor did for 6 of 8 of
  the measures
• Dramatic for all info needed, ongoing medical
  prob, health concerns main visit reason
• Patients thought their doctor had less
  information than their doctor did for 2 of 8
  measures
• Concerns about costs of care visits to other
  health professionals

• Physicians often perceive they are missing
  important clinical information at the end of
  elderly primary care visits
• Patients physicians agree on how much
  information the physician had ½ to ¾ of visits
• Patients have valuable info that physicians do
  not have 4-19 of the time, esp. about other
  health professional visits the concerns about
  costs of care
• Strategies are needed to get physicians the
  information they need before elderly primary care
  visits
• Pre-visit planning intervention underway

Grant support Agency for Healthcare Research
Quality R01 , PI Karsh / Wetterneck