OBJECTIVES: To explore resident physician-patient interaction in primary ca
re to address issues relevant to quality of care for older people. DESIGN:
A sample of 509 new, adult, nonpregnant patients was assigned to the care o
f second- and third-year residents in primary care clinics. Care was compar
ed for three subgroups of patients: older patients (65 years or older; n =
45), those aged 18 to 44 years (n = 320), and those aged 45 to 64 years (n
= 144).
SETTING: Observations were made at the family medicine and general internal
medicine clinics at the University of California, Davis.
MEASUREMENTS: Self-report by means of the Medical Outcomes Study Short Form
-36 (MOS SF-36) was used to determine patient demographics and patient heal
th status. Two measures of satisfaction were obtained gauging reaction to m
edical care in general and to the videotaped visit specifically. Videotapes
were coded for content using the Davis Observation Code.
RESULTS: Self-reported health status of older persons was poorer than that
of younger groups as measured by the MOS SF-36. Differences in demographics
were explored and then controlled, along with physical health status in su
bsequent analyses. Supporting prior studies, this study found that older pa
tients had more return visits and reported higher levels of satisfaction th
an did younger comparison groups. Contrary to prior literature, older patie
nts were found to have longer visits than did younger cohorts. The physicia
n-patient interaction was significantly different in many areas between the
se three groups. Whereas older patients experienced more chatting in their
visits, they were given less counseling, asked fewer questions, had less di
scussion about their families and their use of substances, were asked to ch
ange their health behavior habits less often, and were given less health ed
ucation. For older patients, more of each visit was spent checking on compl
iance with earlier treatment and developing treatment plans.
CONCLUSIONS: These results provide a new and more detailed view of how resi
dent physician-patient interaction differs between older and younger groups
and raise important issues on whether quality of care needs for this popul
ation are being adequately addressed, particularly regarding mental health
issues.