HEALTH PROMOTION IN PRIMARY-CARE - PHYSICIAN-PATIENT COMMUNICATION AND DECISION-MAKING ABOUT PRESCRIPTION MEDICATIONS

To examine health promotion in a primary-care context, we studied perc eived and actual communication in 271 consultations between general pr actitioners and patients in Oxford (England). Although health promotio n is a term usually reserved For public-health or wellness programs, a health promotion perspective enriches the examination of communicatio n in physician-patient interactions by emphasizing issues of empowerme nt, competence and control. Accordingly, we are interested in how comm unication during medical encounters can improve patients' abilities to exercise appropriate control over their health. A major factor in ena bling patients to increase control over their health involves developi ng their competencies for making decisions and enacting behaviors that can lead to desired, and attainable, health outcomes. This report foc uses on communication and decision making about prescription medicatio ns, since whether and how to use medications are among the most common and important decisions in which patients can participate. Five instr uments were employed to collect data about physicians, patients and th eir consultations: a Video Analysis, which allowed assessment of actua l communication behavior; a Patient Questionnaire designed to gauge pe rceptions of the encounter and collect demographic information; a Medi cal-Record Review, which provided information on utilization, diagnosi s and treatment; a Telephone Interview, conducted 14 days after the co nsultation to obtain follow-up information (e.g. experience with the p rescribed medication); and a Doctor Questionnaire that focused on atti tudes toward consultations and patients. With respect to communication about prescription medications, physicians most frequently mentioned product name (78.2% of consultations) and instructions for use (86.7% of consultations). Patients were extremely passive, rarely offering th eir opinion or initiating discussion about any aspect of the treatment . We suggest that improving patients' decision-making competencies may require more discussion of benefits and risks, as well as discussion of patients' opinions about the prescribed medications and their abili ties to follow through with the treatment plans. The research design p roved useful in highlighting discrepancies between perceived and actua l communication. Physicians tended to overestimate the extent to which they discussed patients' ability to follow the treatment plan, elicit ed patients' opinion about the prescribed medication and discussed ris ks of the medication. And, 24.3% of the patients left the consultation with an 'illusion of competence', a belief that important topics had been discussed when,in fact, they had not been mentioned at all. The p attern of results illustrates the complexity of health promotion in pr imary care, and underscores the importance of attending to both percei ved and actual communication in medical encounters.