Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Abstract

BackgroundAlthough studies are available on patients' ideas, concerns, and expectations in primary care, there is a scarcity of studies that explore the triad of ideas, concerns, and expectations (ICE) in general practice consultations and the impact on medication prescribing. AimTo evaluate the presence of ICE and its relation to medication prescription. Design of studyCross-sectional study. SettingThirty-six GP teaching practices affiliated with the University of Ghent, in Flanders, Belgium. MethodParticipants were all patients consulting on 30 May 2005, and their doctors. Reasons for an encounter (consultation or home visit) with new and follow-up contacts, the identification of ICE, and the prescription of medication were recorded by 36 trainee GPs undergoing observational training. The study included 613 consultations. ResultsOne, two, or three of the ICE components were expressed in 38.5%, 24.4%, and 20.1% (n = 236, 150, 123) of contacts respectively. On the other hand, in 17.0% (104/613) of all contacts, and in 22% (77/350) of the new contact reasons, no ICE was voiced, and the GPs operated without knowing this information about the patients. Mean number of ICE components per doctor and per contact was 1.54 (standard deviation = 0.54). A logistic regression analysis of the 350 new contacts showed that the presence of concerns (P = 0.037, odds ratio [OR] 1.73, 95% confidence interval [CI] = 1.03 to 2.9), and expectations (P = 0.009, OR = 2.0, 95% CI = 1.2 to 3.4) was associated with not prescribing new medication (dichotomised into the categories present/absent); however, other patient, doctor, and student variables were not significantly associated with medication prescription. ConclusionAn association was found between the presence of concerns and/or expectations, and less medication prescribing. The data suggest that exploring ICE components may lead to fewer new medication prescriptions.

Health literacy: a necessity for increasing participation in health care

“…19 As a basic first step, health professionals should consider the health literacy of their patients while exploring their 'ideas, Editorials concerns, and expectations'. 26 There is evidence that once low health literacy is considered, healthcare professionals do try to modify their communication, but checking understanding using the 'teach back' technique (asking patients to repeat back information and instructions) and use of visual models are more effective and less commonly used techniques. 27 It would be helpful to heighten awareness of the importance of patient literacy and numeracy skills during medical undergraduate and specialist training, so that all doctors are equipped with the skills they need to support patients.…”

“…These findings are in line with an earlier systematic review conducted in the US. 26 More comprehensive interventions, aimed both at improving patient knowledge and empowerment as well as better sensitisation of service providers to the difficulties experienced by individuals with low literacy are considered to be more effective. 19 As a basic first step, health professionals should consider the health literacy of their patients while exploring their 'ideas, Editorials concerns, and expectations'.…”

Which practices are high antibiotic prescribers? A cross-sectional analysis

“…24 These GPs may feel they have less opportunity to discuss patients' concerns and expectations during a consultation, resulting in more medication being prescribed. 25 Doctors also often overestimate patients' expectations regarding antibiotics, 26,27 and some GPs still prescribe antibiotics in an effort to maintain good doctor-patient relationships. 28 However, several studies have shown that patient satisfaction is more strongly associated with the time GPs spend listening to patients, 29 and providing information and reassurance.…”

Predictors of patient-initiated reconsultation for lower respiratory tract infections in general practice

“…Eliciting concerns and expectations is associated with less medication prescribing, both in general and in antibiotic prescribing decisions in particular. 4,14 Moreover, describing the often longer than realised natural course of LRTI and addressing ongoing patient concerns may lead to fewer reconsultations. Finally, it may also be enlightening to realise that not prescribing antibiotics at index consultation does not mean that patients are more likely to reconsult.…”