A digital appointment agenda-setting tool may prepare patients for an office visit, but providers still need to engage patients in communication.
Health IT may be effective for eliciting patient preferences and giving patients a voice in appointment agenda-setting, but only so long as providers then use that information during the visit, concluded a study published in the Annals of Family Medicine.
Evidence shows that setting an agenda before an appointment ensures patients and providers are on the same page about certain health concerns and are better able to address all of those concerns. With providers facing more stringent clinical quality guidelines and demands for strong chronic disease management, setting an agenda will be key to ensuring they fulfill all of those requirements.
Furthermore, agenda-setting may better situate patients and providers to address key patient needs, leading to meaningful shared decision-making.
“In the time-limited environment of primary care, many patients may have important concerns that are not addressed,” the research team from Kaiser Permanente Northern California wrote. “Examples of prevalent issues that are frequently unrecognized by clinicians during clinic visits include medication-related concerns, financial problems, and stress related to caregiving.”
However, clinicians usually find themselves strapped for time, unable to assess and then fulfill each of those competing demands.
Patient-facing technologies have the potential to create efficiencies in the primary care setting, experts agree. And as more family physicians work to integrate the patient’s point of view into appointment agenda setting, these types of tools can be helpful.
But these tools are only as useful as patients and providers actually use them.
A study of 750 English- or Spanish-speaking patients at Kaiser revealed that while a waiting room tool, called Visit Planner, eliciting patient preferences for appointment agenda-setting yielded substantial patient use, it did not necessarily improve patient care.
Although the patients who used Visit Planner were more likely to have prepared questions and key priorities for their doctors before the visit, they did not have higher satisfaction levels compared to the control group. Additionally, a six-month follow-up revealed that both groups had closed care gaps at equal rates.
These results may suggest that Kaiser can only improve patient care coordination and shared decision-making so much, the team posited.
“Kaiser Permanente Northern California is an integrated health care system that uses a proactive, team-based approach to identify and close clinical care gaps,” the researchers explained.
“In this system, frequent communication and regular outreach by multiple care team members (eg, primary care physicians, medical assistants, population management nurses, and pharmacists) outside of the traditional visit tend to mitigate many of the visit-based barriers that patients and physicians may face when confronted by time limitations.”
Thus, less integrated health systems may benefit more from a Visit Planner tool.
However, it may also indicate that clinicians did not actually use the patient preferences gleaned from Visit Planner.
Although a patient walked into the appointment knowing what she wanted to discuss, her providers may not have been as collaborative. In fact, study results show that patients in both arms of the study did not feel fully engaged, even after agenda-setting. There was room for clinicians to improve in shared decision-making and understanding patient needs.
This is not to say providers disregarded patient preferences to be obstinate. A provider survey conducted by the researchers revealed that clinicians still felt enormous time pressure, despite the use of a digital patient engagement tool. Clinicians recognized the value that integrating patient preferences into care may have.
“The insufficient time during visits reported by our study physicians underscores the challenges clinicians face in addressing patient concerns during time-limited visits,” the researchers concluded. “Our physician survey results suggest that efforts to prepare patients for their visits may represents a potential pathway to the overall goal of improving primary care.”
Separate studies have indicated that waiting room materials to enable patient engagement in appointment agenda-setting improves patient satisfaction.
Research from Duke University School of Medicine revealed that a one-page patient preference worksheet yielded improvements in a clinics CAHPS scores.
“From a patient standpoint, this simple tool helps them feel and know their doctor is listening to them and addressing their concerns,” said lead author Oren Gottfried, MD, clinical vice chair for quality in the Department of Neurology at Duke University School of Medicine. “From a physician standpoint, it very clearly tells them their patients’ goals, which means everyone’s time is used effectively. And doctors, like anyone, appreciate real-time feedback, including positive comments from patients.”
Date: March 18, 2019