The Nature and Prevalence of Patient Expectations in a VA General Medicine Clinic

Abstract

PURPOSE: Patients' expectations influence clinicians' prescribing and referral behaviors, yet little is known about their specific expectations for care. We conducted this study to describe the nature, prevalence and fulfillment of expectations patients present to their clinicians and their relationship to satisfaction. METHODS: Subjects were recruited from a random sample of patients visiting a VA general medicine outpatient clinic. Interviewers administered a face-to-face, structured questionnaire designed to assess patients' expectations before the visit. Afterwards, patients identified the services they received and rated their satisfaction with the visit using the ABIM Patient Satisfaction Questionnaire (PSQ) and Ware Visit Specific Questionnaire (VSQ). RESULTS: We approached 401 patients, of whom 253 (63%) completed both the pre- and post-visit interviews. The remaining 148 patients either refused (16%), did not complete the interview (21%), or were unable to understand the questions (<1%). The median age was 65; 68% were white and the majority had completed high school. 31% of patients reported one expectation and 25% had two or more expectations. Patients' expectations were extremely varied, falling into 40 different categories of tests, referrals, and new medications, and many were vague, as 40% could not be categorized. 50% of patients who expressed an expectation did not receive their desired service. Nevertheless, patient satisfaction was high. Median scores on the VSQ and PSQ respectively were 1.5 and 1.0 (1 = excellent, 5 = poor). Patients with one or more unmet expectations did not differ significantly from patients with all expectations met on the VSQ and PSQ (p = .308 and p = .502, respectively). Only patients who expected a new medication but did not receive it reported lower levels of satisfaction (p = .002). CONCLUSION: Patients present to VA primary care providers with multiple and varied expectations for tests, referrals, and new medications, and many of these expectations are not met. However, patient satisfaction remains high and is largely unrelated to fulfillment of expectations. Further research should examine attributes of the clinical encounter that result in high satisfaction despite unmet expectations.