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In Uncategorized on May 14, 2010 at 5:54 pm

The Satisfied Patient: Overprescribed and Costly

Charles P. Vega, MD

Patient Satisfaction and Outcomes: An Introduction

Patient satisfaction is an important outcome of healthcare delivery, and patient requests for products or services factor into the equation that produces satisfaction. Research demonstrates that physicians may be too open to requests for specific medications.

In a 2000 study, the satisfaction scores of 200 patients were correlated with disease outcome variables, and patient-centered care was associated with lower rates of death and in-hospital complications.[1] However, patient-centered care was also associated with higher healthcare costs.

This review focuses on a 2010 study by Paterniti and colleagues[2] that revealed surprising prescribing patterns, based on standardized patients’ request for treatment. The researchers also analyzed physicians’ responses to these requests and offers strategies to improve patient satisfaction while practicing evidence-based medicine.[2]

Communication is at the heart of patient-centered care, but requests for specific tests or treatments can strain the dialogue between physician and patient. In a study of 887 patients, 84% reported making at least 1 request during their office visit with a physician.[3] Approximately 80% of these requests were granted, and acquiescence to these requests improved patients’ perceptions of their care. Of note, patients who had their requests fulfilled experienced fewer symptoms and health concerns at follow-up, but denial of patient requests did not change post-visit outcomes.

In another study of patient and clinician behaviors, patient requests for specialty referrals increased the odds of referral by more than 4 times, and prescription requests increased the odds of getting a prescription nearly 3-fold.[4] Physicians noted that visits with patients were more demanding when patients requested diagnostic tests.

The issue of patient requests for medications is particularly sensitive in this era of direct-to-consumer advertising for prescription drugs. A study compared rates of requests for specific prescription drugs in the United States, where pharmaceutical advertising is legal, with those in Canada, where it is not.[5]

Patients in the United States were more than twice as likely to request specific pharmaceutical agents, and patients who reported greater exposure to prescription drug advertising were more likely to request these medications.

How did physicians respond to these requests? They were nearly 17 times more likely to prescribe new medications to patients who made a request for an advertised medication, even though many physicians made it clear that they would not use these same advertised prescriptions for other patients with similar diagnoses.

References

1. Bechel DL, Myers WA, Smith DG. Does patient-centered care pay off? Jt Comm J Qual Improv. 2000;26:400-409.
2. Paterniti DA, Fancher TL, Cipri CS, Timmermans S, Heritage J, Kravitz RL. Getting to “no” strategies primary care physicians use to deny patient requests. Arch Intern Med. 2010;170:381-388. Abstract
3. Kravitz RL, Bell RA, Azari R, Krupat E, Kelly-Reif S, Thom D. Request fulfillment in office practice: antecedents and relationship to outcomes. Med Care. 2002;40:38-51. Abstract
4. Kravitz RL, Bell RA, Azari R, Kelly-Reif S, Krupat E, Thom DH. Direct observation of requests for clinical services in office practice: what do patients want and do they get it? Arch Intern Med. 2003;163:1673-1681.
5. Mintzes B, Barer ML, Kravitz RL, et al. How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. CMAJ. 2003;169:405-412. Abstract
6. Fiscella K, Franks P, Srinivasan M, Kravitz RL, Epstein R. Ratings of physician communication by real and standardized patients. Ann Fam Med. 2007;5:151-158. Abstract
7. Jackson JL, Kroenke K. The effect of unmet expectations among adults presenting with physical symptoms. Ann Intern Med. 2001;134(9 Pt 2):889-897.
8. van Bokhoven MA, Koch H, van der Weijden T. Influence of watchful waiting on satisfaction and anxiety among patients seeking care for unexplained complaints. Ann Fam Med. 2009;7:112-120. Abstract

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