Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Abstract

Background: Primary care providers (PCPs) are often challenged to address multiple patient concerns during time-limited visits. The need for PCPs to limit the number of issues addressed may have a negative impact on discussion of patient-defined visit priorities. Methods: Using data from a recent clinical trial (Aligning Patients and Providers, ClinicalTrials.gov: NCT02707146), we examined the association between patient-defined visit priorities and subsequent provider actions taken during and after the visit. We tested the hypothesis that psychosocial concerns (eg, stress, anxiety, caregiving demands) are less likely to be addressed than traditional medical concerns. Results: We analyzed 147 patient-defined visit priorities submitted just before the visit by 109 patients (mean age, 59.0 ؎ 12.7 years; including 73.4% women, 47.7% non-White race/ethnicity). Nearly one quarter of patient-defined visit priorities were related to psychosocial concerns (35/147; 23.8%). In models adjusting for age, gender, race/ethnicity, and familiarity with PCP, patients' psychosocial priorities were significantly less likely than medical priorities to be addressed during the visit (63% vs. 88%; adjusted odds ratio [aOR], 0.16; 95% CI, 0.06 to 0.41; P < .001), to receive clinical action (51% vs. 82%; aOR, 0.15; 95% CI, 0.06 to 0.38; P < .001), or to receive post visit information from the primary care doctor (17% vs. 32%; aOR, 0.39; 95% CI, 0.14 to 1.08; P ‫؍‬ .07). Conclusions: Patient-defined psychosocial priorities are less likely to be addressed during (or immediately after) primary care visits compared with patient-defined medical priorities.

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Scope and activities of Māori health provider nurses: an audit of nurse–client encounters

“…The undocumented problems mostly fall within the psychosocial domain, which has shown to have low documentation in other primary care record studies. 2,18,19 Non-documentation of problems can reflect the medicalisation of the electronic health record and the lack of a nursing lens. One reflection, which the nurses in this study had, was that they felt cautious in documenting items such as spirituality or whakapapa (Māori geneology) when they knew that the notes would be viewed by a doctor from outside the organisation, and that feedback that the nurses had received from external doctors was that they only wanted to receive 'short, sharp notes that related to medical problems'.…”

Identifying patients with psychosocial problems in general practice: A scoping review

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