EFFECTS OF A SELF-ADMINISTERED PREVISIT QUESTIONNAIRE TO ENHANCE AWARENESS OF PATIENTS CONCERNS IN PRIMARY-CARE

OBJECTIVE: To determine if a self-administered previsit questionnaire designed to increase awareness of patients' concerns alters the visit duration, content of the discussion, and patient and physician satisfa ction. DESIGN: A balanced, two-arm trial in which physicians were rand omized. SETTING: Two primary-care clinics affiliated with a university hospital. PATIENTS/PARTICIPANTS: Ten physicians and 201 continuity-ca re patients. INTERVENTIONS: In intervention visits, patients completed a previsit questionnaire asking about the desire for medical informat ion, psychosocial assistance, therapeutic listening, general health ad vice, and biomedical treatment. Physicians reviewed questionnaires wit h patients during the visit. MEASUREMENTS AND MAIN RESULTS: We used au diotapes of encounters to quantify the duration of the encounter and m easured the number and type of diagnoses discussed in the visit, and p atient and physician satisfaction with the encounter. Intervention vis its were 34% longer (increase of 6.8 minutes; 95% confidence interval [CI] 0.4, 13.2) than control visits with most of the additional time s pent in discussion of biomedical diagnoses (3.35 minutes; 95% CI 0.00, 6.72) and in the performance of the physical examination (2.7 minutes ; 95% CI 0.5, 4.9). The number of diagnoses discussed per visit was 30 % higher in intervention visits (increase of 1.7 diagnoses per visit; 95% CI 0.3, 3.2), but patients' satisfaction with these visits tended to be lower. CONCLUSIONS: Using a previsit questionnaire to increase a wareness of the patients' concerns may entail a trade-off between conf licting goals: trying to respond to patient concerns while not signifi cantly increasing the cost per visit. A future challenge is to develop and refine techniques with sufficient efficacy to justify the expense of implementing the intervention and the longer visit needed to respo nd adequately to patients' concerns.