How do patients rate communication and time spent with their doctor or other health professional?

In 2002, more than one-half of adults and almost three-quarters of parents reported that health professionals always communicated well and spent enough time with them. Among adults, ratings tended to increase by age group. Ratings were lower for those in fair to poor health than among those in better health.

Why is this important?

The quality of communication between patients and their health professionals can affect patients' receptivity to receiving advice, their adherence to treatment regimens, and their satisfaction with outcomes of care (Stewart et al. 2000; Stewart 1995). Likewise, the amount of time that patients spend with clinicians may affect their ability to fully explain their personal needs and raise questions about their diagnosis and treatment.

Findings

Across all age groups, about one of 10 patients or parents (7% to 13%) gave ratings suggesting potentially serious problems with interpersonal quality of care during visits to doctors' offices in 2002. Those reporting themselves, or their child, to be in relatively worse health were more likely to give ratings suggesting gaps in care (14% to 17%) than those who reported relatively better health (7% to 10%).

• Parents reported the most positive experiences with interpersonal quality of care: nearly three-quarters (73%) said that their child's doctor always listened carefully, explained things clearly, showed respect, and spent enough time with them during pediatric visits in 2002.
• In contrast, only one-half of young adults (51%) who visited a doctor during 2002 reported that their doctor always met expectations for these interpersonal aspects of care. Seniors (61%) gave relatively better ratings on average than nonelderly adults (AHRQ 2005).

Implications

Ratings of interpersonal care might reflect a variety of factors, including the mix of visits for preventive or sick care. Children often visit the doctor for preventive care, while young adults are eligible for fewer preventive services than older adults. The fact that seniors gave relatively higher ratings to interpersonal quality of care is encouraging given that they often have more complex needs than younger adults.

Improvement Ideas and Resources

Several types of interventions directed at both physicians and patients might be effective in improving physician–patient interactions and patient outcomes, such as:

• education and incentives for health professionals and their staff to help improve patient-centered communication skills (Lewin et al. 2001);
• culturally relevant questionnaires, written and audiovisual materials, and coaching or skills training to help prepare patients (and their family members) for effective health care encounters (Cegala et al. 2001; Post et al. 2002);
• interpreter services and teams of professionals that include at least one bilingual professional to overcome language barriers (Brach and Fraser 2000);
• use of mid-level practitioners (physician assistants and nurse practitioners) to increase time spent with patients during intake and follow-up care (Berry et al. 2003); and
• follow-up services such as telephone calls to determine how the patient is doing post-care (Car and Sheikh 2003).

Measure:

The denominator is community-dwelling children and adults of specified ages who visited a doctor's office for health care in the past year (representing 76 percent of children, ages 0–17; 62 percent of young adults, ages 18–44; 76 percent of middle-age adults, ages 45–64; and 84 percent of elderly adults, ages 65 and older). Those who did not respond or who answered "don't know" were excluded. The numerator is the subset of the denominator population who answered "always," "usually," "sometimes," or "never" to four questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Parents/guardians answered on behalf of children. The four questions are:

• In the last 12 months how often did doctors or other health providers listen carefully to you?
• In the last 12 months how often did doctors or other health providers explain things in a way you could understand?
• In the last 12 months how often did doctors or other health providers show respect for what you had to say?
• In the last 12 months how often did doctors or other health providers spend enough time with you?

Limitations:

Parent responses do not fully capture the experience of adolescents if the parent was not present at a health care visit or during confidential counseling times.

Source:

Data are derived from the Self-Administered Questionnaire (SAQ) and Child Health Sections of the 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the civilian, noninstitutionalized population of the United States conducted by the Agency for Healthcare Research and Quality (AHRQ 2004).

References:

* Indicates source of data used in the chart(s).

AHRQ (Agency for Healthcare Research and Quality). 2004. National Healthcare Quality Report, 2004. AHRQ Pub. No. 05-0013. Rockville, Md.: U.S. Department of Health and Human Services.

* AHRQ (Agency for Healthcare Research and Quality). 2005. National Healthcare Quality Report, 2005. AHRQ Publication No. 06-0018. Rockville, Md.: U.S. Department of Health and Human Services.

Berry, L. L., K. Seiders, and S. S. Wilder. 2003. Innovations in Access to Care: A Patient-Centered Approach. Annals of Internal Medicine 139 (7): 568–74.

Brach, C., and I. Fraser. 2000. Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model. Medical Care Research and Review 57 Suppl 1: 181–217.

Car, J., and A. Sheikh. 2003. Telephone Consultations. BMJ 326 (7396): 966–9.

Cegala, D. J., D. M. Post, and L. McClure. 2001. The Effects of Patient Communication Skills Training on the Discourse of Older Patients During a Primary Care Interview. Journal of the American Geriatrics Society 49 (11): 1505–11.

Gross, D. A., S. J. Zyzanski, E. A. Borawski et al. 1998. Patient Satisfaction with Time Spent with Their Physician. The Journal of Family Practice 47 (2): 133–7.

Lewin, S. A., Z. C. Skea, V. Entwistle et al. 2001. Interventions for Providers to Promote a Patient-Centred Approach in Clinical Consultations. Cochrane Database of Systematic Reviews (4): CD003267.

Post, D. M., D. J. Cegala, and W. F. Miser. 2002. The Other Half of the Whole: Teaching Patients to Communicate with Physicians. Family Medicine 34 (5): 344–52.

Stewart, M., L. Meredith, J. B. Brown et al. 2000. The Influence of Older Patient–Physician Communication on Health and Health-Related Outcomes. Clinics in Geriatric Medicine 16 (1): 25–36, vii–viii.

Stewart, M. A. 1995. Effective Physician–Patient Communication and Health Outcomes: A Review. Canadian Medical Association Journal 152 (9): 1423–33.