Patient Characteristics Associated with Making Requests during Primary Care Visits

Abstract

Background: Patient requests for tests, treatments, or referrals occur frequently during primary care visits and pose challenges for clinicians to address, but little is known about patient characteristics that may predict requests.Objective: To identify patient characteristics associated with a higher rate of patient requests during primary care visits.Design, Setting, and Sample: Cross-sectional analyses of data from 1141 adult patients attending 1319 visits with 56 primary care physicians (including 45 resident and 11 faculty physicians) in an academic family medicine practice.Measurements: Postvisit patient surveys including measures of patient requests for tests, prescriptions, and referrals; sociodemographics; mental and physical health status; symptom bother or worry (3-item scale; range, 3 to 15; Cronbach's ␣ ‫؍‬ 0.83); global life satisfaction; medical skepticism; and Five Factor Model personality traits.Results: Patients made 1 or more requests in 867 visits (65.7%). In multivariate analyses of the within-visit request count, the following patient variables were statistically significantly associated with a higher rate of requests: age in years (incidence rate ratio [IRR], 1.01 [95% CI, 1.00 to 1.01]), increased symptom bother or worry (IRR, 1.06 [95% CI, 1.03 to 1.08]), a more extroverted personality (IRR, 1.12 [95% CI, 1.03 to 1.08]), greater life satisfaction (IRR, 1.01 [95% CI, 1.00 to 1.02]), and any prior encounter with the visit physician (IRR, 1.17 [95% CI, 1.04 to 1.32]).Conclusions: Primary care physicians should expect a greater frequency of requests from older patients, patients with greater symptoms bother or worry, more extroverted patients, patients with greater global life satisfaction, and patients with whom they have had prior visits. (J Am Board Fam Med 2019; 32:201-208.)

Perceptions of Residents among Rural Communities with Medical Group Practice in Japan

“…The lower approval of telemedicine in older residents was speculated to be due to their perception of this type of healthcare being technically difficult to use or their preference for receiving a direct clinical consultation with a physician. These explanations may be supported by a previous observation that people with chronic diseases are more likely to prefer face-to-face contact with a physician [12]. Indeed, in the present study, considerably more residents in the older group had hypertension and a history of cerebral infarction than in the younger group.…”

“…Regarding the rotation of physicians on a daily or weekly basis in GP-R, approximately half of residents in each group approved of this practice; however, older residents disapproved of this more than younger ones. This may be related to the general assumption that older residents are used to or prefer a more traditional, face-to-face patient-physician relationship [12].…”

When Physicians Say No: Predictors of Request Denial and Subsequent Patient Satisfaction

“…Life satisfaction may be associated with attitudes toward medical care in general, and is not a factor that can be changed by physicians. We showed in previous work that higher life satisfaction was related to more patient requests during physician visits and to greater overall visit satisfaction, 9,30 and other past work has shown the importance of life satisfaction as a stronger predictor of visit satisfaction than patient sociodemographic characteristics. 12 Patients with the highest level of education, more than a college degree, were significantly more likely to be dissatisfied after a denial compared with patients with a high school education or less.…”

“…Patients with greater symptom burden were also more likely to report request denials. In our past work, 30 more symptomatic patients were more likely to request multiple tests or treatments, plausibly in an effort to reduce symptom burden or mitigate uncertainty, and therefore may have a greater chance of having at least 1 request denied. The denial might be intentional (based on the physician's judgment that the service is unnecessary or premature) or unintentional (based on the physician's failure to recognize the request, which may not have been explicit and unambiguous).…”

Regional differences in the patient population of general practices in northern Germany: results of a mixed-methods study

“…According to Fenton et al, higher rates of requests for tests, prescriptions and referrals in family medicine practices were significantly associated with age, greater bother or worry about symptoms, a more extroverted patient personality, greater life satisfaction and a higher probability of at least one prior encounter with the physician that had been visited. 9 Ferroni et al demonstrated that the management of non-insulin-treated type II diabetes was insufficient in younger patients, immigrants and patients not attending diabetes clinics. 10 Van den Bussche et al analysed the overutilisation of ambulatory medical care in the elderly German population.…”