Midst growing time pressures on physicians, there is a need to maintain and even enhance the quality of physician-patient encounters, particularly for vulnerable, older adults with chronic conditions. Substantial research suggests that older adults are more passive than other age groups during their visits. Hence, physicians may miss key information about patient concerns and regimens that could affect health outcomes. This research addresses gaps identified by literature reviews calling for studies evaluating interventions that efficiently elicit patient pre-visit expectations for physicians and examine the longitudinal effect of expectation fulfillment on patient outcomes. The goal of this research is to study the impact of an intervention that identifies pre-visit concerns of older adult patients and then prompts both patients and physicians to address these concerns in the visit. Older adults' functional status concerns will be identified briefly in the waiting room using a handheld computer. A printout summarizing patient responses will be given both to the physician and patient. We hypothesize that this prompt will affect the nature of the patient-provider encounter in such a way that health outcomes will be improved. To test these hypotheses, a final sample of 580 patients age 60 or older, with a formal diagnosis of rheumatoid arthritis will be enrolled at their clinic visit. A one-year randomized, controlled experiment will be used in which an experimental group patients receive a computerized assessment and prompt about their visit concerns while a control group receives a parallel placebo computerized assessment of their exercise patterns. In both cases, patient assessment summaries are given to the patients and to their physicians in the medical record. Baseline, 6 month and 12 month data will be collected on each patient. We hypothesize improved health status at 12 months for the primary outcomes of pain and physical function. Selected encounter dynamics hypothesized to help explain these outcomes will also be examined. We will audiotape patient-physician encounters to study these interaction dynamics. The primary analyses will examine differences at 12 months between the control and experimental groups using ANCOVA for continuous variables with baseline values of outcomes as a covariate, Dichotomous outcomes will be analyzed primarily by the Mantel Haenszel test and logistic regression.
| Santiago, Vivian; Raphael, Karen; Chewning, Betty (2016) Pain Predicts Function One Year Later: A Comparison across Pain Measures in a Rheumatoid Arthritis Sample. Pain Res Treat 2016:7478509 |
| Chewning, Betty; Bylund, Carma L; Shah, Bupendra et al. (2012) Patient preferences for shared decisions: a systematic review. Patient Educ Couns 86:9-18 |
