OBJECTIVE: To determine whether an intervention designed to improve patient-physician communication increases the frequency with which
physicians elicit patients’ concerns, changes other communication behaviors, and improves health care outcomes.
DESIGN: Pretest-posttest design with random assignment of physicians to intervention or control groups.
SETTING: General medicine clinics of a university-affiliated Veterans Affairs Hospital.
PATZEWTS/PARTICIPANTS: Forty-two physicians and 348 continuity care patients taking prescription medications for chronic medical conditions.
INTERVENTIONS: Intervention group physicians received 4.5 hours of training on eliciting and responding to patients’ concerns and requests,
and their patients filled out the Patient Requests for Services Questionnaire prior to a subsequent clinic visit. Control
group physicians received 4.5 hours of training in medical decision-making.
MEASUREMENTS AND MAIN RESULTS: The frequency with which physicians elicited all of a patient’s concerns increased in the intervention group as compared
with the control group (p=.032). Patients perceptions of the amount of information received from the physician did increase significantly (p<.05), but the actual magnitude of change was small. A measure of patient satisfaction with the physicians was high at baseline
and also showed no significant change after the intervention. Likewise, the intervention was not associated with changes in
patient compliance with medications or appointments, nor were there any effects on outpatient utilization.
CONCLUSIONS: A low-intensity intervention changed physician behavior but had no effect on patient outcomes such as satisfaction, compliance,
or utilization. Interventions may need to focus on physicians and patients to have the greatest effect.
Key words doctor-patient communication - patient satisfaction - ambulatory care
Portions of this paper were presented at the annual meeting of the Society of General Internal Medicine, Washington, DC, May
1992. The title of the poster was “Effects of an educational program to increase elicitation of patient concerns.” The abstract
was published in Clin. Res. 1992;40:614A.
This project was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research
and Development Service as Investigator Initiated Research project HR 89.054, by the Northwest Health Services Research and
Development Field Program, and by the Portland, Oregon Veterans Affairs Medical Center.