Submitted in response to PA-98-059 Health care Encounters between Elderly patients, physicians, and other care providers. This is a pilot project (R03) PA 11-15-99.
Specific Aims of this project are: 1) to examine the feasibility of doing a randomized controlled trial (RCT) to examine the impact of a companion attending an older patient's medical encounter. 2) to develop a reliable coding system to assess physicians' family interviewing skills from transcripts of the accompanied-encounters. 3) to examine the association between family interviewing skills and a patient and companion satisfaction with the medical encounter (mediating variables). 4) to examine the differences between the effects of accompanied encounters and non-accompanied encounter Significance: If we were to find that partner accompanied encounters and physician family interviewing skills have a positive effect on patient outcomes, then our results would suggest that physicians should welcome accompanied encounters with older patients and that they should receive additional training in family interviewing skills. This intervention study and the analysis of family interviewing skills will enable us to develop protocols that will help physicians provide care effectively to patients who are accompanied to encounters. Methods: 50 patients will be randomly assigned to attend a scheduled appointment with their physician accompanied or not accompanied by a family member. We will recruit patients who have scheduled appointments, through letters, telephone calls, and a brief home visit. Since this is a pilot, we are seeking to find the most efficient and cost-effective method to recruit patients into a trial such as this. Patients will complete a questionnaire before the visit. We will audiotape and transcribe the medical encounters. Patients and/or companions will complete a short post-session questionnaire to assess their satisfaction with the visit along with other dependent variables. We will make a 1-week follow-up phone call to assess patients' recall and understanding of what transpired in the medical visit. We will make a 3-month follow-up phone call to reassess dependent variables. Patient recall will be compared for accuracy with the transcript of the session using a session topic and treatment recommendation evaluation form we devised. We will develop a Family Interviewing Skills coding system to code the transcripts. We will use lag sequential analysis to analyze physician- patient/companion interaction. Our goal is to identify physician behaviors that maximize cooperative responses from patients and companions. We will use the results of this study to develop an R01 application to conduct a larger study in primary care practices in the community.
| Moens, An L; Kass, David A (2007) Therapeutic potential of tetrahydrobiopterin for treating vascular and cardiac disease. J Cardiovasc Pharmacol 50:238-46 |
| Shields, Cleveland G; Epstein, Ronald M; Fiscella, Kevin et al. (2005) Influence of accompanied encounters on patient-centeredness with older patients. J Am Board Fam Pract 18:344-54 |
