THE EFFECT OF A SECONDARY PATIENT ON THE FAMILY-PRACTICE VISIT

BACKGROUND. This study describes how the provision of care to a family member other than the identified patient affects the outpatient famil y practice visit. METHODS. Research nurses directly observed consecuti ve patient visits on 2 separate days in the offices of 138 practicing family physicians. Patient visits during which another family member's problem was addressed were identified. Differences in patient and vis it characteristics, patient satisfaction, delivery of preventive servi ces, and lime use, measured with the Davis Observation Code, were comp ared for visits with and without the provision of care to a family mem ber. RESULTS. Care was provided to a secondary patient during 18% of o bserved outpatient visits. The secondary patient was present during on ly half of these visits. When another family member's problem was disc ussed, patients were more likely to report that their expectations for the visit were met. There was no difference in patient report of sati sfaction with the visit, the delivery of preventive services, or the l evel of billing for visits at which another family member's problem wa s addressed. Visits during which another family member's problem was d iscussed were an average of 1.3 minutes longer; with less time spent c hatting, providing feedback, and conducting physical examinations, and more lime spent counseling, taking history, gathering family informat ion, and delivering preventive services. CONCLUSIONS. The provision of care to a second family member is relatively common in family practic e, and affects the care of the index patient in identifiable ways. Thi s care of another family member represents an important added value of family practice.