Patient-physician Partnership Research Articles

Increasing Efficiency in Addressing Patient Portal Messaging Demands on Healthcare Systems (P6-7.006)

<h3>Objective:</h3> To evaluate healthcare value of messaging through patient portals based on the relationship of maximum patient message length versus content communicated. <h3>Background:</h3> Patient portals are designed to empower individuals to be partners in their care and reduce administrative burdens. Overall adoption has been positive with studies demonstrating improvement in outcomes with increased use. However, recent studies have shown that high volume of messages increases physician workload and contributes to burnout. Specifically, length of the message has been described as a contributing factor. Here we evaluate a database of messages to determine key descriptive statistics towards identifying methods to increase efficiency in addressing messaging demands. <h3>Design/Methods:</h3> Retrospective review of patient portal messages through the Epic MyChart platform from January 1 to June 30, 2022 at a single large academic outpatient neurology clinic (general &amp; subspecialities). Message character length was obtained through a basic character count using Microsoft Excel (MAC version 16.65). Descriptive statistics were calculated from the sample to derive insights on patterns. Through an optimization scenario - maximum message length was reduced in order to determine number of messages affected versus content reduced. <h3>Results:</h3> There were 10,118 messages from 2,646 patients. Length ranged from 1 to 1500 characters resulting in a total of 2,946,290 characters. Message length followed a decreasing exponential distribution, with majority of messages in lower character ranges. Quartiles from first to fourth were: 88, 202 (median), 386, and 1500 (max). Limiting character count to 750 characters, affected 807 (8%) messages. Reducing these messages to 750 characters decreased the overall character count by 11%. <h3>Conclusions:</h3> Patient portal messaging has become an important part of the patient-physician partnership. This analysis evaluated an optimization strategy of reducing character count in order to determine workload impact. Limiting maximum length to 750 characters led to a disproportionate reduction in workload compared to a smaller number of messages affected. <b>Disclosure:</b> An immediate family member of Dr. Gordon-Kundu has received personal compensation for serving as an employee of Ceretype . An immediate family member of Dr. Gordon-Kundu has received personal compensation in the range of $0-$499 for serving as a Consultant for Hyperfine. An immediate family member of Dr. Gordon-Kundu has stock in Hyperfine. Dr. Khokhar has nothing to disclose.

Medical informed choice: understanding the element of time to meet the standard of care for valid informed consent

Medical informed choice is essential for a physician meeting their fiduciary duty when proposing medical and surgical actions, and necessary for a patient to consent or cull the outlined therapeutic...

An international experience of electronic communication and implementation of eHealth solutions in a vascular surgery clinic.

Communication is key to any successful relationship with the patient-physician partnership being no different. Recent advances in technology have provided us with an array of new communication tools such as the mobile phone, computer, internet, and email. This new technology has revolutionized communications; however, limitations to their widespread use include access, literacy, and willingness for both the physician and patient to change. To gather international data, questionnaires were completed by patients attending vascular surgery outpatient clinics in hospitals in Ireland and Canada. Five hundred ninety-seven patients participated in the study. Of the participants, 83.2% were over 50years old. The mean age was 63.1years, with a range of 18-95years. Overall, home phone call was the most preferred method of communication with 41.0% of patients selecting this option. Of the patients, 82.4% had a mobile phone but just 48.5% use text message. In those over the age of 70, 72.1% use a mobile phone and just 25.3% use text message. Of the participants, 64.1% had access to a computer, and 67.2% had access to the internet with a decline in the usage of both with increasing age. Within this patient population, the use of technologies decreases with increasing age of the patients. This demonstrates a large population of service users who are contented with conventional methods of communication. Change within healthcare ICT is inevitable, and therefore, these patients need to be guided and educated to allow a smooth transition from the old to the new.

Across sectional study on patients with inflammatory rheumatic diseases in terms of their compliance to their immunsuppressive medication during COVID-19 pandemic

Die aktuelle Pandemie mit COVID-19 stellt die behandelnden Rheumatologen vor eine bisher nicht dagewesene Herausforderung. Auf der einen Seite können antirheumatische Medikamente das Infektrisiko erhöhen und den Verlauf einer Infektion beeinflussen. Auf der anderen Seite erhöht eine unzureichend kompensierte entzündlich-rheumatische Erkrankung ebenfalls das Infektionsrisiko. Gemäß der Empfehlung der Deutschen Gesellschaft für Rheumatologie (www.dgrh.de) empfehlen wir unseren Patienten trotz Pandemie eine Fortführung der antirheumatischen Therapie zum Erhalt der Remission. Im Rahmen dieser Studie wurden Patienten mit einer entzündlich-rheumatischen Erkrankung bezüglich ihrer Meinung zu ihrer immunmodulierenden Therapie unmittelbar nach Beginn der hochaktiven Phase der Pandemie befragt. An der Datenerhebung waren 5 Kliniken und 6 niedergelassene rheumatologische Versorger beteiligt. Hierbei zeigte sich, dass über 90 % der Befragten der ärztlichen Empfehlung zur Fortführung der antirheumatischen Therapie folgten. Lediglich ein geringer Prozentsatz wollte die Therapie eigenmächtig beenden. Diese Einstellung der Patienten war unabhängig von der jeweiligen antirheumatischen Therapie. Dieses Ergebnis ist aus rheumatologischer Sicht erfreulich, spiegelt die vertrauensvolle und kompetente Betreuung der rheumatologischen Patienten wider, und zeigt, dass trotz solcher Herausforderungen unsere Patienten unseren Empfehlungen folgen.

The Effects of Participating in a Physician-Driven Online Health Community in Managing Chronic Disease: Evidence from Two Natural Experiments

This research examines physician-driven online health communities (OHC), a social media application in healthcare that engages both patients and physicians. Drawing on the “patient–physician partnership” paradigm in managing chronic disease (Bodenheimer et al. 2002), we argue that physician-driven OHC facilitates patient–physician collaborative care and self-management support, which may improve patient well-being and patient–physician relationships. We test the mutual impact between patients’ and physicians’ participation in physician-driven OHC and the impact of patients’ and physicians’ participation on patient well-being and the patient–physician relationship in the context of managing diabetes and depression. We collect data from a leading Chinese online consultation platform. To make credible causal inference, we exploit two events that separately create plausibly exogenous variations in patients’ and physicians’ participation. We find that physicians’ participation significantly increases patients’ participation for both diabetes and depression, but patients’ participation only increases physicians’ participation for depression. Although both patients’ and physicians’ participation significantly improve patient well-being and the patient–physician relationship, there are interesting nuances in these effects over time. These findings have important implications for self-managing chronic diseases and healthcare policy making.

“I had already made up my mind.” The impact of prior experience and health care perceptions on decision making in women with early-stage breast cancer.

228 Background: Shared decision-making (SDM) occurs when informed patients partner with their oncologists to incorporate personal preferences into treatment. Even before engaging with an oncologist about treatment options, patients may have personal experiences or knowledge of other’s experiences with breast cancer that frame their decision-making. This study sought to understand how prior experiences and knowledge drive preferences in early stage breast cancer treatment approaches. Methods: This qualitative study included early stage breast cancer (BC) patients at an academic medical center in the Deep South. Women age ≥18 with an AJCC stage I-III BC diagnosis were invited to complete semi-structured interviews with a trained interviewer. Interviews were audio-recorded, transcribed, and analyzed by two independent coders utilizing a constant comparative method from an a priori conceptual model based on the Ottawa Framework. Major themes and exemplary quotes related to decision-making preferences were extracted. Results: Women (n = 33) interviewed were an average age of 74 (4.2 SD), and 19% of participants were African American. Many women were given the option to omit treatments, such as chemotherapy or radiation therapy, based on hormone receptor status and axillary node involvement. Major themes related to a desire for more treatment were past experiences with family members having cancer or an impression that additional treatment would be more effective. For women that opted out of treatments, prior knowledge of potential physical side effects from friends, family, and other cancer survivors were cited as a major deterrent. Perceptions of low recurrence risk also influenced desire to forgo treatments. Conclusions: Women presenting with early stage BC had varied healthcare experiences, which resulted in preconceived ideas about receiving breast cancer treatments. Consideration of these themes may aid physicians’ ability to address individual concerns to further personalize patient care, thus enhancing the patient-physician partnership. These findings will ultimately assist in improving patient engagement in SDM.

AB026. 151. Review of communication methods in a vascular surgery clinic

Background: Communication is key to any successful relationship with the patient-physician partnership being no different. Recent advances in technology have provided us with an array of new communication tools such as the mobile phone, the computer, the internet and email. This new technology has revolutionised communications, however, limitations to their widespread use include access, literacy and willingness for both the physician and patient to change.

Patient-Physician Communication in the 21st Century

In clinical practice, a successful patient-physician partnership can improve the outcome of treatment, especially in cases of chronic disease or cancer. To establish this partnership, physicians must explain treatment options and potential outcomes, but how to best do this when treatment is based on scientific principles and findings that the lay patient will not be familiar with? Here we present a paradigm for patient-physician communication using the immunotherapy of cancer as a model. In this context, we argue for the importance of incorporating techniques in communicating science with patients into the training of early career physicians.

DSM-5 and culture: The need to move towards a shared model of care within a more equal patient–physician partnership

The universal models employed by psychiatry de-emphasise the role of context and culture. Despite highlighting the impact of culture on psychiatric diagnosis and management in the Diagnostic and Statistical Manual of Mental Disorders-5, most of the changes suggested remain in the introduction and appendices of the manual. Nevertheless, clinical and biological heterogeneity within phenomenological categories mandates the need to individualise care. However, social and cultural context, patient beliefs about causation, impact, treatment and outcome expectations are never systematically elicited, as they were not essential to diagnosis and classification. Patient experience and narratives are trivialised and the biomedical model is considered universal and transcendental. The need to elicit patient perspectives, evaluate local reality, assess culture, educate patients about possible interventions, and negotiate a shared plan of management between patient and clinician is cardinal for success. The biopsychosocial model, which operates within a paternalistic physician-patient relationship, needs to move towards a shared approach, within a more equal patient-clinician partnership.

Validation of a Novel Approach for Dose Individualization in Pharmacotherapy Using Gabapentin in a Proof of Principles Study

To demonstrate the premise of individualized dosing charts (IDCs) as a clinical-bedside decision-support tool to individualize dosage regimens for drugs in which the interpatient variability is controlled by the pharmacokinetic (PK) behavior of the patient, to calculate the optimal sampling schedule (OSS), which minimizes the number of blood samples per patient. The approach is illustrated with available PK data for gabapentin. Retrospective proof of principles study using gabapentin PK data from a published clinical trial. Nineteen subjects in a trial designed to uncover the importance of the genetic contributions to variability in gabapentin absorption, renal elimination, and transport; subjects were monitored for 36hours after administration of a single dose of gabapentin 400mg, and plasma concentrations were determined at 14 time points. When the PK profiles were different between subjects, the IDCs are dramatically different from each other and from the IDC for an "average" patient representing the patient population. The dose amount and dosing interval must be adjusted to maximize the probability of staying within the target concentration range. An optimal sampling methodology based on the assumption-free Bayesian approach is used to distinguish the PK profile of an individual patient from the patient population. In the case of gabapentin, only two optimally selected test blood samples, at 1.5 and 6hours after administration of a single doses, were necessary. The average sensitivity and the average specificity of the OSS was 99% and 96%, respectively. IDCs display the risk of a patient violating the target concentration range for any dosage regimen. They can be used as a clinical-bedside decision-support tool in a patient-physician partnership to decide on a dose amount and dosing interval that are medically acceptable while practical and convenient to ensure compliance. By using the assumption-free Bayesian approach and the OSS, the number of samples required from a new patient to individualize the dosage regimen can be reduced significantly while preserving high levels of sensitivity and specificity. Prospective studies are being planned to validate the encouraging results. This approach can be extended to any drug if PK data and a target concentration range are available for either therapeutic drug monitoring or target concentration intervention.

Associations Between Aspects of Culturally Competent Care and Clinical Outcomes Among Patients With Diabetes

Culturally competent care may be associated with clinical outcomes in diabetes management, which requires effective physician-patient collaboration. The recent development and validation of the Consumer Assessment of Healthcare Providers and Systems Cultural Competence tool enables investigation of possible associations. To assess whether 3 aspects of culturally competent care are associated with glycemic, lipid, and blood pressure control among ethnically diverse patients with diabetes. Survey and chart review study of patients recruited from urban safety net clinics in 2 cities. A total of 600 patients with type 2 diabetes and a primary care physician. We used multivariate logistic regression to assess the independent relationships between the 3 domains of the Consumer Assessment of Healthcare Providers and Systems Cultural Competence (Doctor Communication-Positive Behaviors, Trust, and Doctor Communication-Health Promotion) and glycemic, lipid, and systolic blood pressure control after adjusting for sociodemographic and clinical factors. In adjusted analysis, high Trust was associated with lower likelihood of poor glycemic control (odds ratio, 0.59; 95% confidence interval, 0.41-0.84) and high Doctor Communication-Health Promotion was associated with a higher likelihood of poor glycemic control (odds ratio, 1.49, 95% CI, 1.02-2.19). None of the 3 aspects of culturally competent care examined were associated with lipid or systolic blood pressure control after adjustment. Trust in physician, a core component of culturally competent care, but not doctor communication behavior, was associated with a lower likelihood of poor glycemic control in a safety net population with diabetes. Glycemic control may be more sensitive to patient physician partnership than blood pressure and hyperlipidemia control.

Reasons for inadequate asthma control in children: an important contribution from the “French 6 Cities Study”

Reasons for inadequate asthma control in children: an important contribution from the “French 6 Cities Study”

Going It Together: Persistence of Older Adults’ Accompaniment to Physician Visits by a Family Companion

Although older adults are often accompanied to routine physician visits and commonly receive disability-related task assistance, the overlap and persistence of this help is not well understood. This study investigates whether older adults who are accompanied to routine physician visits (1) also receive task assistance and (2) continue to be accompanied at 12-months by the same family companion. Observational study. Nationally representative survey. Community-dwelling adults aged 65 and older who responded to the Medicare Current Beneficiary Survey (MCBS) in 2006 (n=11,582) and a subset (n=7,510) who responded in 2005 and 2006. Accompaniment to physician visits by a family companion and receipt of task assistance with activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Persistent accompaniment and consistent family companion involvement was ascertained from 2005 and 2006 survey responses. Among community-dwelling older adults, 18.6% were accompanied to physician visits only, and 12.7% were accompanied to physician visits and received task assistance. Accompanied older adults who received task assistance were older, less educated, and had worse self-rated health than their counterparts who were accompanied only. Family companions who provided task assistance (vs those who did not) were more actively engaged in physician visit processes and more often identified as always present. Three-fourths (74.5%) of accompanied older adults were persistently accompanied to physician visits at 12months, nearly always (87.9%) by the same family companion. Receipt of task assistance was strongly associated with persistent accompaniment (aOR=2.52; 95% CI:1.93-3.29). Older adults' accompaniment to physician visits typically persists, most often by consistently involved family companions. Findings have implications for the patient-physician partnership and the patient-centered medical home.

Using Patients to Promote Evidence-Based Prescribing

Billions of dollars are spent each year on drugs with unproven clinical effectiveness and limited safety records. Sales of ezetimibe totaled over $4 billion per year in 2010 despite little evidence of benefit on meaningful clinical outcomes as a substitute or adjunct to statin therapy.1 Millions of people were early adopters of rofecoxib (Vioxx) and rosiglitazone (Avandia), only to see these drugs withdrawn or restricted due to safety concerns. What can be done to increase rational prescribing? In this issue of the Archives, Schwartz and Woloshin report on a patient-oriented approach to promote use of drugs with proven clinical benefit and a well-established track record of safety.2 In a survey of 2,944 adults, they presented 2 highly-simplified case scenarios. The first case involved the choice between 2 hypothetical lipid-lowering drugs. Both drugs have identical safety profiles, but drug A has a proven clinical benefit – reducing heart attacks – while drug B has only been shown to lower cholesterol. Participants were randomized into three groups: (1) receiving only the above information, (2) receiving the information plus a brief warning highlighting that it is not known whether drug B improves clinical outcomes, or (3) the information, warning, and a directive statement to “ask for a drug shown to reduce heart attacks.” When asked which drug they would prefer, 59% of participants in the information-only group chose the drug with evidence of clinical benefit. In contrast, 71% of participants in each of the 2 warning groups chose this drug. The authors obtained similar results from a second scenario that focused on favoring drugs with a long established track record of safety. As with the first scenario, the 2 warning groups were more likely to choose the better (in this case, older) drug, with 34% of participants in the information-only group selecting the older drug vs. 53% in each of the warning groups. What can this warning-based approach teach us about improving prescribing? It depends on whether one sees the study results as a glass half-empty or half-full. On the positive side, a simple warning improved patient decision-making. On the other hand, seemingly irrational decisions persisted to a striking degree. One in three participants preferred a drug with no evidence of clinical benefit despite explicit instructions to ask for a drug known to confer benefit (and no discernible reason to favor the inferior drug). In the second scenario, half of participants chose a newer heartburn drug despite explicit directions to ask for a drug for a longer track record of safety. It’s not only patients who make such illogical decisions. Physicians are equally well-established in our proclivity to favor new, relatively untested medications and to prescribe contrary to guidelines.3 These contrasting perspectives highlight the challenges and opportunities to use Schwartz and Woloshin’s findings to improve care. Simply adding warnings to patient educational materials is unlikely to meaningfully increase rational prescribing. Other influences on prescribing are strong, physicians are often unaware of the evidence basis for drugs they prescribe, and educational interventions alone typically have minimal impact on behaviors.4-6 Nonetheless, giving patients warnings and instructions may be of substantial value if we also provide them the tools to help them successfully advocate for their own care. Such patient activation programs can dovetail with other system-based approaches that align the incentives of patients and physicians toward evidence-based care. For example, a recent study used letters, financial incentives, and phone calls to encourage patients with hypertension to discuss thiazide diuretics with their physician.7 The approach was highly successful in increasing the number of patients taking thiazides, and was welcomed by patients and physicians alike because both felt that it served their interests. Similarly, other work has shown that outcomes in older adults transitioning from hospital to home can be substantially improved by coaching patients about how to talk with their doctors and advocate for themselves.8 Many physicians have first-hand experience with situations where highly engaged patients (or their caregivers) identified an error, potential treatment, or other opportunity to improve care that would otherwise have been missed. We work within a health care environment whose complexity and incentives makes it difficult to consistently provide the care to which we aspire. We are thus well-served by being open to approaches that build the patient-physician partnership to improve quality of care. These efforts need to be paired with systems improvements that promote high-quality prescribing, help physicians respond to patient questions, and align the incentives of patients, physicians, and health care systems. Patient activation programs are a valuable tool to provide better care. We should take full advantage.

In This Issue: From Apprehension to Action

Thirty years ago, Ian McWhinney described “the importance of the physician in…mobilizing the patient’s inner resources and working with him as a partner in the healing process.”[1][1] This concept of a trusting patient-physician partnership has long been an ideal of family medicine and

Review article: the functional abdominal pain syndrome

Functional abdominal pain syndrome (FAPS) is a debilitating disorder with constant or nearly constant abdominal pain, present for at least 6 months and loss of daily functioning. To review the epidemiology, pathophysiology and treatment of FAPS. A literature review using the keywords: functional abdominal pain, chronic abdominal pain, irritable bowel syndrome and functional gastrointestinal disorders. No epidemiological studies have focused specifically on FAPS. Estimates of prevalence range from 0.5% to 1.7% and tend to show a female predominance. FAPS pathophysiology appears unique in that the pain is caused primarily by amplified central perception of normal visceral input, rather than by enhanced peripheral stimulation from abdominal viscera. The diagnosis of FAPS is symptom-based in accordance with the Rome III diagnostic criteria. These criteria are geared to identify patients with severe symptoms as they require constant or nearly constant abdominal pain with loss of daily function and are differentiated from IBS based on their non-association with changes in bowel habit, eating or other gut-related events. As cure is not feasible, the aims of treatment are reduced suffering and improved quality of life. Treatment is based on a biopsychosocial approach with a therapeutic patient-physician partnership at its base. Therapeutic options include central nonpharmacological and pharmacological modalities and peripheral modalities. These can be combined to produce an augmentation effect. Although few studies have assessed functional abdominal pain syndrome or its treatment specifically, the treatment strategies outlined in this paper appear to be effective.

Therapeutic Patient Education: A new deal for medical education?

Nowadays, in developed countries with an aging population, chronic diseases necessitates the largest amount of medical care and their complications represent the main causes of hospitalization and of health costs. Differently from acute conditions, whose control largely depends on the physician, chronic diseases require the patients’ compliance and their active involvement in the management of their daily life, thanks to a transfer of medical competencies. The concepts of patient’s empowerment, patient–physician partnership and therapeutic alliance, which are more and more frequently discussed in the medical literature, are directly linked to this new attribution of roles and responsibilities within the frame of chronic diseases. Since the pioneering study of Miller & Goldstein (1972), who showed that the education of young diabetics in the Los Angeles County Hospital results in an important reduction of admissions and costs, Therapeutic Patient Education (TPE) has been recognized by World Health Organization (WHO 1998) as a major component of the treatment and long-term follow-up of many long-term diseases. At present, a large number of TPE programs are routinely held for several chronic diseases (diabetes, asthma, chronic heart failure, rheumatoid arthritis, obesity, etc.) in different settings (hospital, community health, etc.), evaluated by an increasing amount of meta-analyses and randomized control trials (Albano et al. 2009). WHO defines TPE as a process enabling the chronic patient and his family ‘‘to manage his treatment and prevent avoidable complications while maintaining or improving his quality of life’’. TPE programs are planned, run and evaluated by multiprofessional teams of health care providers, trained in the methodology of patient education. Even if modern medical curricula (Dent & Harden 2009) pay considerable attention to the patient–physician communication and expose the students to some educational methodologies (learning how to learn, peer-teaching, lifelong learning, etc.), this might be insufficient to prepare the future physician to teach efficiently the patient and/or to manage a

Die Bedeutung der Patientensicht bei der Erfassung der Sicherheit neuer Medikamente

using data from the German biologics register RABBIT we investigated which gain in information can be achieved by integrating patient-reported adverse drug reactions (ADRs) into drug surveillance systems. patients with rheumatoid arthritis enrolled in the longitudinal cohort of the German biologics register between May 2001 and September 2006 who had undergone at least one follow-up were included in the study. All ADRs reported to the register either by the treating rheumatologists or the patients were coded with the same coding system (MedDRA®). The agreement between patients and physicians was analysed for the most frequently reported ADRs using the patient as gold standard. data from 4246 patients with a mean observation time of 2 years were analysed. Patients reported on average 1.2 ADRs per patient year (PY), while physicians indicated 1 ADR per PY (p<0,001). The ADR most frequently reported by patients was nausea (93.8 per 1000 PY), followed by fatigue (72.5 per 1000 PYs) and alopecia (60.6 per 1000 PYs). These ADRs were significantly less often reported by physicians. Agreement between patients and physicians was higher in more objective symptoms, such as injection site reaction (in 60.0% of cases where the patient reported this symptom, the physician did so too) or rash (53.0%), than in more subjective symptoms such as fatigue (17.4%). Agreement was highest in life-threatening events. patients report a higher number of ADRs than their treating physicians. Patients report subjective symptoms impacting on quality of life more frequently than physicians. Patient-physician agreement on known or clinically relevant ARDs is high. Integration of patient reports on ADRs into clinical routine could enhance the patient-physician partnership and improve compliance as well as awareness of signs and symptoms of possible ADRs.

The patient-physician partnership in asthma: Real-world observations associated with clinical and patient-reported outcomes

It is hypothesized that a good partnership between asthma patients and their physicians has a direct and positive influence on the patients' clinical and patient-reported outcomes. Conversely, poor partnership has a detrimental effect on clinical and patient-reported outcomes. This paper uses data from a real-world observational study to define partnership through matched physician and patient data and correlate the quality of partnership with observed clinical and patient-reported outcomes. Data were drawn from Adelphi's Respiratory Disease Specific Programme, a cross-sectional study of consulting patients in five European countries undertaken between June and September 2009. A range of clinical and patient-reported outcomes were observed allowing analysis of the partnership between 2251 asthma patients and their physicians. Analysis demonstrates that the better the partnership between patient and physician, the more likely the patient is to have their asthma condition controlled (P<0.001), to experience fewer exacerbations (P<0.001), to have better quality of life (P<0.001), to have fewer sleep disturbances (P<0.001), and to have fewer patient-reported symptoms (P<0.001). Partnership is also associated with lower impact on lifestyle (P<0.01) and reduced days lost at work/school (P<0.05), and with patient satisfaction with their inhaler device (P<0.05). The patient-physician partnership is a contributory factor in the improvement of asthma treatment, and patient education may lead to improvement in a patient's ability to contribute to this. Device satisfaction is one of the markers of good partnership.

A randomized controlled trial of interventions to enhance patient-physician partnership, patient adherence and high blood pressure control among ethnic minorities and poor persons: study protocol NCT00123045

BackgroundDisparities in health and healthcare are extensively documented across clinical conditions, settings, and dimensions of healthcare quality. In particular, studies show that ethnic minorities and persons with low socioeconomic status receive poorer quality of interpersonal or patient-centered care than whites and persons with higher socioeconomic status. Strong evidence links patient-centered care to improvements in patient adherence and health outcomes; therefore, interventions that enhance this dimension of care are promising strategies to improve adherence and overcome disparities in outcomes for ethnic minorities and poor persons.ObjectiveThis paper describes the design of the Patient-Physician Partnership (Triple P) Study. The goal of the study is to compare the relative effectiveness of the patient and physician intensive interventions, separately, and in combination with one another, with the effectiveness of minimal interventions. The main hypothesis is that patients in the intensive intervention groups will have better adherence to appointments, medication, and lifestyle recommendations at three and twelve months than patients in minimal intervention groups. The study also examines other process and outcome measures, including patient-physician communication behaviors, patient ratings of care, health service utilization, and blood pressure control.MethodsA total of 50 primary care physicians and 279 of their ethnic minority or poor patients with hypertension were recruited into a randomized controlled trial with a two by two factorial design. The study used a patient-centered, culturally tailored, education and activation intervention for patients with active follow-up delivered by a community health worker in the clinic. It also included a computerized, self-study communication skills training program for physicians, delivered via an interactive CD-ROM, with tailored feedback to address their individual communication skills needs.ConclusionThe Triple P study will provide new knowledge about how to improve patient adherence, quality of care, and cardiovascular outcomes, as well as how to reduce disparities in care and outcomes of ethnic minority and poor persons with hypertension.