Treatment should take into consideration factors such as transportation, income, researchers say
MONDAY, April 15, 2013 (HealthDay News) -- Health care outcomes improve when patients inform their doctors about what is going on in their lives, according to a new study.
Researchers found that discussion about personal matters that may be clinically relevant -- such as problems with money or transportation -- allows doctors to gather important information that will help them individualize care.
"What our study really tells us is that the information that patients divulge during appointments about their life situation is critical to address and take into account if we're looking for optimal health care outcomes," study lead author Dr. Saul Weiner, professor of medicine, pediatrics and medical education at the University of Illinois at Chicago, said in a university news release.
In conducting the study, researchers from the University of Illinois at Chicago and the U.S. Department of Veterans Affairs had about 800 actual patients secretly audio record visits with nearly 150 different doctors at two VA facilities in Chicago. Although all the doctors involved in the study agreed to be involved in the study, they did not know which patients would be recording their conversations.
"Incognito audio recording provides accurate information about how doctors practice that you can't obtain any other way," the study's co-author, Alan Schwartz, professor and associate head of medical education at UIC, said in the news release.
The doctors were scored on how well they individualized patients' care and considered important red flags that could impact health outcomes, including financial problems, lack of transportation, competing responsibilities and social support.
Failure to address these issues can lead to "contextual issues," the study authors said. "If the patient has, for example, a chronic condition like diabetes or hypertension that's going out of control, we would say that's also a contextual issue and probably a sign that something is going on in that patient's life that needs to be addressed," said Weiner, who also is a staff physician at the Jesse Brown VA Medical Center in Chicago.
Each doctor was continuously recorded until they had three patient visits with a contextual red flag. Overall, the study included more than 400 patient visits with about 550 red flags. Of these red flags, more than 200 contextual factors relevant to treatment were confirmed during the office visits.
The researchers also followed the patients for nine months to assess their health and the success of their treatment.
The study found that doctors took into account important contextual factors when determining a treatment strategy 59 percent of the time. In these instances, there was a positive health outcome 71 percent of the time.
In the 41 percent of cases in which doctors did not make a contextualized care plan, a positive outcome resulted 46 percent of the time. The remaining 54 percent of these cases had poor outcomes, the researchers said.
The study was published in the April 16 issue of the journal Annals of Internal Medicine.
Although it might seem obvious that, for example, a way for doctors to get a patient who has no access to transportation to keep their medical appointments is to refer them to a clinic-supported van service, "this is the first study to document an association between contextualizing patient care and patient care outcomes," Weiner said in the news release.
The American Academy of Family Physicians has more about how to build a doctor-patient relationship (http://www.aafp.org/online/etc/medialib/fmig/documents/medschool/survivingpdfs/relationships.Par.0001.File.dat/tips_relationships.pdf ).
SOURCE: University of Illinois at Chicago, news release, April 15, 2013