FIELDING STANDARDIZED PATIENTS IN PRIMARY-CARE SETTINGS - LESSONS FROM A STUDY USING UNANNOUNCED STANDARDIZED PATIENTS TO ASSESS PREVENTIVECARE PRACTICES

Objectives. To document detection and suspicion rates of unannounced s tandardized patients visiting community-based practices. Design. Prima ry care physicians were recruited to participate in a study using stan dardized patients. Four standardized patient scenarios were used. Sett ing. Community-based primary care physicians' practices in southern On tario between September 1994 and August 1995. Study participants. Sixt y-two primary care physicians. Main outcome measures. A 'believability ' questionnaire completed after all four standardized patients had vis ited the practices. Results. Of the primary care physicians approached 50% (62) agreed to participate. Twenty-one per cent of all visits wer e suspected as standardized patient encounters. Forty-six per cent sus pected one or more standardized patients. Only five physicians (8%) su spected all four standardized patients. Reasons for suspecting standar dized patients were associated with the characteristics of the physici an's practices, the physician's practice profile and the standardized patient cover story. Conclusion. The portrayal of asymptomatic patient s seeking a new primary care physician presents unique challenges. Car efully constructed cover stories, and detailed knowledge of the local area and of the practices of the participating physicians is required to allow standardized patients cases to be tailored to fit into primar y care settings without arousing suspicion.