Multilinear regression models were used to assess the impact of age, sex, race, education, number of physician visits, health improvement and life satisfaction, and continuity of care on provider communication (“The doctor or provider listened to you and talked with you about your care”) and level of patient influence (“Your ability to influence the treatment you received from a doctor or provider for your health problems”). For asthmatic patients, the quality of provider communication was only dependent on continuity of care (p = 0.01). Continuity of care (p = 0.02) and life satisfaction (p = 0.04) were the only variables contributing to the level of patient influence for asthmatic patients. For nonasthmatic patients, continuity of care, age, number of physician visits, general health, health improvement, and life satisfaction all contributed to patients’ perceptions of quality for provider communication (p < 0.01); these variables also contributed significantly to patient influence (p < 0.008). read only
Therefore, continuity of care may be relatively more important to patients with asthma than to other patients with frequent health-care use. Quality communication between physicians and patients is also necessary for patient-focused care, but this can be difficult to achieve in the limited time available for consultation and if patients’ needs are complex. It is important for physicians to realize that many factors may be brought into the consultation, not just the presenting symptoms. An interesting study by Kravitz et al evaluated the expectations of 688 patients prior to and after their visit to an internist’s office. Following the visit, there were 125 patients (18.2%) who had unmet expectations related to physician preparation for the visit (23.2%), history taking (26.4%), physical examination (29.6%), diagnostic testing (28.0%), referral to specialists (26.4%), prescription of medication (19.2%), and physician/patient communication (15.2%). The framework for patients’ perception of unmet expectations was complex and determined by their current somatic symptoms (74%), perceived vulnerability to illness (50%), past experiences with similar illnesses (42%), and knowledge acquired from physicians, family, friends, or the media (54%). This study illustrates that patients’ expectations may not be explicit and need to be actively sought in order for them to be addressed, either by meeting them or by negotiation.