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Do unmet expectations for specific tests, referrals, and new medications reduce patients’ satisfaction?

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Abstract

BACKGROUND: Patient-centered care requires clinicians to recognize and act on patients’ expectations. However, relatively little is known about the specific expectations patients bring to the primary care visit.

OBJECTIVE: To describe the nature and prevalence of patients’ specific expectations for tests, referrals, and new medications, and to examine the relationship between fulfillment of these expectations and patient satisfaction.

DESIGN: Prospective cohort study.

SETTING: VA general medicine clinic.

PATIENTS/PARTICIPANTS: Two hundred fifty-three adult male outpatients seeing their primary care provider for a scheduled visit.

MEASUREMENTS AND MAIN RESULTS: Fifty-six percent of patients reported at least 1 expectation for a test, referral, or new medication. Thirty-one percent had 1 expectation, while 25% had 2 or more expectations. Expectations were evenly distributed among tests, referrals, and new medications (37%, 30%, and 33%, respectively). Half of the patients who expressed an expectation did not receive one or more of the desired tests, referrals, or new medications. Nevertheless, satisfaction was very high (median of 1.5 for visit-specific satisfaction on a 1 to 5 scale, with 1 representing “excellent”). Satisfaction was not related to whether expectations were met or unmet, except that patients who did not receive desired medications reported lower satisfaction.

CONCLUSIONS: Patients’ expectations are varied and often vague. Clinicians trying to implement the values of patient-centered care must be prepared to elicit, identify, and address many expectations.

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References

  1. Greenfield S, Kaplan SH, Ware JE Jr. Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med. 1985;102:520–8.

    PubMed  CAS  Google Scholar 

  2. Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank HJL. Patient participation in medical care: effect on blood sugar and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.

    Article  PubMed  CAS  Google Scholar 

  3. Krupat E, Bell RA, Kravitz RL, Thom D, Azari R. When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust. J Fam Pract. 2001;50:1057–62.

    PubMed  CAS  Google Scholar 

  4. Kroenke K. Patient expectations for care: how hidden is the agenda? May Clin Proc. 1998;73:191–3.

    CAS  Google Scholar 

  5. Zemencuk JK, Feightner JW, Hayward RA, Skarupski KA, Katz SJ. Patients’ desires and expectations for medical care in primary care clinics. J Gen Intern Med. 1998;13:273–6.

    Article  PubMed  CAS  Google Scholar 

  6. Hafferty FW, Light DW. Professional dynamics and the changing nature of medical work. J Health Soc Behav. 1995;35:132–53.

    Article  Google Scholar 

  7. Brody DS, Miller SM, Lerman CE, Smith DG, Lazaro CG, Blum MJ. The relationship between patients’ satisfaction with their physicians and perceptions about interventions they desired and received. Med Care. 1989;27:1027–35.

    Article  PubMed  CAS  Google Scholar 

  8. Kravitz RL, Cope DW, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visits. J Gen Intern Med. 1994;9:75–81.

    Article  PubMed  CAS  Google Scholar 

  9. Kravitz RL, Callahan EJ, Azari R, Antonius D, Lewis CE. Assessing patients’ expectations in ambulatory medical practice. J Gen Intern Med. 1997;12:67–72.

    Article  PubMed  CAS  Google Scholar 

  10. Joos SK, Hickam DH, Borders LM. Patients’ desires and satisfaction in general medicine clinics. Public Health Rep. 1993;108:751–9.

    PubMed  CAS  Google Scholar 

  11. Uhlmann R, Inui T, Pecoraro R, Carter W. Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes. J Gen Intern Med. 1988;3:458–63.

    Article  PubMed  CAS  Google Scholar 

  12. Eisenthal S, Emery R, Lazare A, Udin H. ‘Adherence’ and the negotiated approach to patienthood. Arch Gen Psych. 1979;36:393–8.

    CAS  Google Scholar 

  13. Soh G. Patient satisfaction with physician care. Hawaii Med J. 1991;50:149–52.

    PubMed  CAS  Google Scholar 

  14. Hickson GB, Clayton EW, Entman SS, et al. Obstetricians’ prior malpractice experience and patients’ satisfaction with care. JAMA. 1994;272:1583–7.

    Article  PubMed  CAS  Google Scholar 

  15. Marquis MS, Davies AR, Ware JE Jr. Patient satisfaction and change in medical care provider: a longitudinal study. Med Care. 1983;21:821–9.

    Article  PubMed  CAS  Google Scholar 

  16. Cleary PD, McNeil BJ. Patient satisfaction as an indicator of quality care. Inquiry. 1988;25:25–36.

    PubMed  CAS  Google Scholar 

  17. Uhlmann R, Inui T, Carter W. Patient requests and expectations: definitions and clinical applications. Med Care. 1984;22:681–5.

    Article  PubMed  CAS  Google Scholar 

  18. Kravitz RL, Bell RA, Franz CE. A taxonomy of requests by patients (TORP): a new system for understanding clinical negotiation in office practice. J Fam Pract. 1999;48:872–8.

    PubMed  CAS  Google Scholar 

  19. Brody H. The Healer’s Power. New Haven, Conn: Yale University Press; 1992.

    Google Scholar 

  20. Vanderford ML, Stein T, Sheeler R, Skochelak S. Communication challenges for experienced clinicians: topics for an advanced communication curriculum. Health Commun. 2001;13:261–84.

    Article  PubMed  CAS  Google Scholar 

  21. Vieder JN, Krafchick MA, Kovach AC, Galluzzi KE. Physician-patient interaction: what do elders want? J Am Osteopath Assoc. 2002;102:73–8.

    PubMed  Google Scholar 

  22. Ferguson WJ, Candib LM. Culture, language, and the doctorpatient relationship. Fam Med. 2002;34:353–61.

    PubMed  Google Scholar 

  23. Marple RL, Kroenke K, Lucey CR, Wilder J, Lucas CA. Concerns and expectations in patients presenting with physical complaints: frequency, physician perceptions and actions, and 2-week outcome. Arch Intern Med. 1997;157:1482–8.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Eisenberg JM. Physician utilization: the state of research about physicians’ practice patterns. Med Care. 1985;23:461–83.

    Article  PubMed  CAS  Google Scholar 

  26. Woolf SH, Kamerow DB. Testing for uncommon conditions: the heroic search for positive test results. Arch Intern Med. 1990;150:2451–8.

    Article  Google Scholar 

  27. Marton KI, Sox HC Jr, Wasson J, Duisenberg CE. The clinical value of the upper gastrointestinal tract roentgenogram series. Arch Intern Med. 1980;140:191–5.

    Article  PubMed  CAS  Google Scholar 

  28. Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in the asymptomatic adult: comparison of physicians’ recommendations, patients’ desires, published guidelines, and actual practice. JAMA. 1985;254:1480–4.

    Article  PubMed  CAS  Google Scholar 

  29. Davis T, Long S, Jackson R, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391–5.

    PubMed  CAS  Google Scholar 

  30. Peck BM, Asch DA, Goold SD, et al. Measuring patient expectations: does the instrument affect satisfaction or expectations? Med Care. 2001;39:100–8.

    Article  PubMed  CAS  Google Scholar 

  31. Kravitz RL. Measuring patients’ expectations and requests. Ann Intern Med. 2001;134:881–8.

    PubMed  CAS  Google Scholar 

  32. PSQ Project Co-Investigators. Final Report on the Patient Satisfaction Questionnaire Project. Washington, DC: American Board of Internal Medicine; 1989.

    Google Scholar 

  33. Ware JE, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care. 1988;26:393–402.

    Article  PubMed  Google Scholar 

  34. Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24:351–7.

    Article  PubMed  CAS  Google Scholar 

  35. Hopton JL, Howie JG, Porter AM. The need for another look at the patient in general practice satisfaction surveys. Fam Pract. 1993;10:82–7.

    Article  PubMed  CAS  Google Scholar 

  36. Williams B. Patient satisfaction: a valid concept? Soc Sci Med. 1994;38:509–16.

    Article  PubMed  CAS  Google Scholar 

  37. Sitzia J, Wood N. Patient satisfaction: a review of issues and concepts. Soc Sci Med. 1997;45:1829–43.

    Article  PubMed  CAS  Google Scholar 

  38. Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med. 1990;30:811–8.

    Article  Google Scholar 

  39. Rahmqvist M. Patient satisfaction in relation to age, health status and other background factors: a model for comparisons of care units. Int J Qual Health Care. 2001;13:385–90.

    Article  PubMed  CAS  Google Scholar 

  40. Anderson LA, Zimmerman MA. Patient and physician perceptions of their relationship and patient satisfaction: a study of chronic disease management. Patient Educ Couns. 1993;20:27–36.

    Article  PubMed  CAS  Google Scholar 

  41. Khayat K, Salter B. Patient satisfaction surveys as a market research tool for general practices. Br J Gen Pract. 1994;44:215–9.

    PubMed  CAS  Google Scholar 

  42. McKinley RK, Middleton JF. What do patients want from doctors? Content analysis of written patient agendas for the consultation. Br J Gen Pract. 1999;49:796–800.

    PubMed  CAS  Google Scholar 

  43. Bell RA, Kravitz RL, Thom D, Krupat E, Azari R. Unmet expectations for care and the patient-physician relationship. J Gen Intern Med. 2002;17:817–24.

    Article  PubMed  Google Scholar 

  44. Kaplan S, Greenfield S, Gandek B, Rogers W. Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996;124:497–504.

    PubMed  CAS  Google Scholar 

  45. Goold SD, Lipkin M Jr. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14:26–33.

    Article  Google Scholar 

  46. Braddock CH III, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282:2313–20.

    Article  PubMed  Google Scholar 

  47. Eisenthal S, Lazare A. Expression of patients’ requests in the initial interview. Psychol Rep. 1977;40:131–8.

    PubMed  CAS  Google Scholar 

  48. Balint J, Shelton W. Regaining the initiative. Forging a new model of the patient-physician relationship. JAMA. 1996;275:887–91.

    Article  PubMed  CAS  Google Scholar 

  49. Mann S, Sripathy K, Siegler EL, Davidow A, Lipkin M, Roter DL. The medical interview: differences between adult and geriatric outpatients. J Am Geriatr Soc. 2001;49:65–71.

    Article  PubMed  CAS  Google Scholar 

  50. Roter DL. The outpatient medical encounter and elderly patients. Clin Geriatr Med. 2000;16:95–107.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to B. Mitchell Peck PhD.

Additional information

This material was based on work supported by the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs (MPC 97-011). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

We also ran analyses using a more narrow definition of expectations than the one described above. Only patients who responded that it was “absolutely” necessary for the doctor to order a test, refer to a specialist, or prescribe a new medication were defined as having these expectations for the visit. We used this narrower definition of expectations to determine whether patients who expressed the highest desire for the service were less satisfied if they did not receive what they wanted. Results were similar when we used a more inclusive definition of expectation. Therefore, we present only the results of expectations defined by patients who responded “absolutely” or “somewhat necessary” for a service.

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Peck, B.M., Ubel, P.A., Roter, D.L. et al. Do unmet expectations for specific tests, referrals, and new medications reduce patients’ satisfaction?. J GEN INTERN MED 19, 1080–1087 (2004). https://doi.org/10.1111/j.1525-1497.2004.30436.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2004.30436.x

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