Patient-Focused Care: Research

Patient-Focused Care: ResearchBiomedical physicians were more focused on the patients’ disease but were unlikely to elicit psychosocial information. High-control physicians dominated the encounter and disregarded the patients’ agenda. These physician styles were compared with patient-evaluated quality attributes in primary care using the Components of Primary Care Instrument and patient satisfaction. Table 1 shows the rankings for the different physician styles against these outcomes and length of visit. There was a significant difference between the different styles for communication, accumulated knowledge, coordination of care, patient satisfaction with physician, and patient expectations met. The person-focused style was ranked first for all of these factors; biopsychosocial was ranked second for four of the five factors, followed by biomedical; and high physician control was the least effective style, ranked last for four of these five elements. The person-focused style was the style most likely to be associated with a positive assessment of patient-determined quality in primary care and patient satisfaction. However, consultations with the person-focused style were longer than with the other styles, which can be a challenge to disseminate widely in primary care. read

Adolescents provide particular challenges for health-care provision and represent a significant proportion of patients with asthma. Teenagers may be making the transition from being a relatively passive participant in the consultation in the presence of their parent, to having to take a more active role as they take responsibility for their health care. A survey of 157 adolescent female patients (aged 14 to 19 years) who were asked to describe the ideal physician found that 87% of the “ideal” characteristics identified related to communication. Medical behavior and other factors determined only 10% and 3% of wanted characteristics, respectively. Within the theme of communication, “understanding” (18%) and “talks to me” (15%) were the most important characteristics, followed by “cares” (10%), “listens” (8%), and “respect” (7%). For young women in this age group, high-quality communication and a focus on them as a person are important needs.

Table 1—Ranking of Different Physician Interaction Styles Based on Patient Scoring of Attributes of Primary Care Quality, Patient Satisfaction, and Length of Visit for 2,881 Patients Visiting 138 Physicians

Patient-Reported Attributes of Primary Care Quality Ranking Based on Physician Interaction Style Significant Difference Between Groups, p Value


Biopsychosocial Biomedical 1High Physician Control
Communication 1 2 3 4 < 0.001
Accumulated knowledge 1 2 4 3 < 0.001
Coordination of care 1 2 3 4 < 0.001
Preference for regular doctor 1 1 3 4 NS
Usual provide continuity 4 1 2 3 NS
Patient satisfaction measures
Patient satisfaction with physician 1 3 2 4 0.002
Patient expectations met 1 2 3 4 0.02
Length of visit, min 11.56 9.97 10.02 9.51 0.005
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