Time constraints force clinicians to pick and choose with preventive care services they’ll touch on in patient-provider communication.
Despite the big role preventive care plays in overall patient wellness, patient-provider communication on the matter leaves much to be desired, according to a new study published in JAMA Network Open.
The study, published by researchers from the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, specifically found that providers often have to prioritize which of many preventive care services they will discuss with their patients. And in doing so, providers may not always be communicating about the most high-yield preventive services, primarily lifestyle changes, the researchers concluded.
“Just 8% of US adults attain all guideline-recommended services,” the researchers said. “Although patient nonadherence is an important factor, in many practice settings, physicians also have limited time to discuss preventive care.”
Want to publish your own articles on DistilINFO Publications?
Send us an email, we will get in touch with you.
Generally, there are 32 evidence-based preventive care services or best practices that the medical field has agreed could improve patient health. In order to adequately discuss those preventive care guidelines with patients, providers would have to spend seven hours of their work days dedicated to preventive care coaching.
However, because of time constraints, providers currently only spend about 27 percent of their days on direct clinical care, forcing them to prioritize what kind of preventive care they will discuss with a given patient.
“Physicians may prioritize care in different ways, such as improving length of life, quality of life, or cost-effectiveness,” the research team pointed out. “However, clinical decision supports focused on these priorities are limited. Instead, physicians must rely on personal impressions of the benefits and harms of each preventive service, taking into account differences across patients in risk factors.”
Researchers generally wanted to know if providers actually prioritize these conversations, and which factors — mainly visit length, patient risk factors, and potential to improve life expectancy — might influence those priorities.
The researchers surveyed 137 physicians about if and how they would prioritize discussions about preventive care, Using a one-to-five sliding scale, 137 study participants rated their likelihood to discuss.
The researchers presented respondents with two simulated patients:
- Patient One, a 50-year-old white woman who has hypertension, type 2 diabetes, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of breast cancer
- Patient Two, a 45-year-old black man with hypertension, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of colorectal cancer
Respondents were presented with both 20- and 40-minute appointment slots with either patient.
The surveys revealed that providers do, in fact, prioritize different preventive care services. Physicians rated their likelihood to prioritize preventive care services at a 4.27. Physicians primarily made these choices based on a certain preventive care measure’s promise to improve the quality or the length of a patient’s life.
Although physicians were likely to prioritize discussions about preventive care services in any appointment, they expressed a greater likelihood to do so during a 20-minute appointment than the 40-minute appointment, the researchers added.
By and large, providers were likely to recommend the same three preventive care strategies to both simulated patients, regardless of clinical differences or risk factors.
For Patient One, physicians recommended smoking cessation, hypertension control, and glycemic control.
For Patient Two, they recommended smoking cessation, hypertension control, and colorectal cancer screening.
Importantly, only one of those three recommendations for either patient included a high-yield preventive service, the researchers pointed out.
“Recommendations were similar across patients, although the patients stood to benefit from different services,” the researchers reported. “Although we do not know why physicians did not individualize the recommendations, they may have used rules-of-thumb, such as the importance of blood pressure control or smoking cessation, rather than attempting to identify which service would provide the greatest benefit for a specific patient.”
Providers also may face challenges in estimating how much a specific preventive care measure will affect an individual patient.
Of note, the researchers found providers were unlikely to discuss lifestyle changes as preventive measures, at least in comparison to a preventive service. This comes even as various models suggest lifestyle changes are among some of the more powerful preventive care measures patients and providers can take.
Clinicians may have been weighing other factors here, such as the likelihood that a patient would adhere to a certain lifestyle change. About half of all providers said likelihood of patient adherence was a key factor in prioritization.
For example, providers know that encouraging diet and exercise changes are challenging, especially in the primary care setting. Although health coaching is a recommended best practice, many primary care providers know that these programs are best delivered in more intensive settings.
This knowledge may dissuade some providers from broaching the subject with patients, instead anticipating better adherence with a certain preventive screening, for example.
“We caution that while considering average adherence rates to interventions (eg, obesity control less likely than hypertension control) may be reasonable, careful consideration should be given before individualizing estimated adherence rates by patient; failure to do so could inadvertently exacerbate health disparities for minorities,” the researchers warned.
Moving forward, it may be reasonable for healthcare industry leaders to better determine how to boost patient engagement in lifestyle change. At the same time, providers may need better supports for determining preventive care services and communication with patients, such as clinical decision support.
Source: Patient Engagement Hit