Diana Dryer Wright

The effects of doctor-patient communication on satisfaction and outcome of care

Abstract From data on a series of 1761 episodes of acute primary care, the chain of relationships between patient expectation, doctor-patient communication, compliance, outcomes of care and satisfaction was examined. Overall few meaningful correlations were found. There was a strong positive relationship between patient satisfaction and functional outcome. Nonetheless, 65% of those patients who failed to regain their usual functional status professed satisfaction with the outcome of their care. Using discriminate analysis, we could predict satisfaction with outcome best by the actual outcome and satisfaction with care. Patient satisfaction with care was in turn best predicted from four variables: satisfaction with outcome, the continuity of care, patient expectation and doctor-patient communication. Implications of both positive and negative findings are discussed.

Relationship between process and outcome in ambulatory care.

The outcomes of a series of some 410 acute episodes from two family practice centers were rated on the degree to which the patient regained his usual functional status and his satisfaction with the outcome and the process of care. A portion of outcomes (251) were then compared to process scores obtained using explicit criteria and the rest to implicit process ratings based on the problem-oriented record. In both instances those cases with good outcomes had better process scores than those with bad outcomes; neither measure of satisfaction had a consistent relationship with either process measure.

Changes in utilization patterns in a National Health Service Corps community.

Utilization patterns in two adjacent rural Utah counties were compared over a span of five years (1971-1976). In one, a three-physician National Health Service Corps site was established during the interval; the other went from one family physician to two during the same period. The Corps site showed an increase in physician utilization while the “control” county utilization remained unchanged. However, despite the increased utilization of physicians in the Corps site, fewer respondents identified a family physician, especially one located within the county. This is consistent with an interpretation that county residents were content to use Corps physicians, but saw them as transitory figures with whom they could form no permanent attachment. A second brief follow-up study a year later suggests that the community had already begun to acknowledge the Corps doctors as their family physicians.

Recent rural health research

Recent rural health research may be examined in two ways: needs and solutions. A definition of needs requires an evaluation of the social factors that affect the expectations and the behavior of both the provider and the consumer. Three types of solutions should be considered: the appropriate utilization of manpower, including the efforts to influence physician location and specialty distribution, new health practitioners, and team approaches; the new technology for transportation and communication; and the organization of new delivery systems.Two areas of rural health research that need more attention are program evaluation and financial planning.

Predicting the Outcome of Primary Care

Each physicians ability to treat disease is limited by his/her ability to discriminate among patients on the basis of risk. The relationships of physician expectation of outcome (prognosis) to actual outcome and to cost were determined for 1,757 patients seeking primary care. Outcome was measured by a seven-level functional-status scale; patients who returned to their usual level of function after an acute illness were defined as having good outcomes. Although 24 per cent of patients experienced bad outcomes, physicians had anticipated only 6 per cent. Physicians predictions of bad outcomes had a sensitivity of 13.6 per cent and a specificity of 96.9 per cent. Patients with bad outcomes had slightly higher laboratory costs than did patients with good outcomes, but a much larger increase was seen in laboratory, office and total costs for all patients for whom physicians expected bad outcomes, regardless of the actual results. A feedback loop is recommended to provide a better perspective on outcome and eventually to improve the efficiency and cost benefit of the medical decisionmaking process.

Predicting rural health care utilization with archival data

This study explored the usefulness of archival data in predicting rural health care utilization. A regression model was used to see how well observed utilization for local populations could be predicted by calculating expected values in advance from age- and sex-specific national rates applied to local age and sex profiles. Although the correlation between observed and expected utilization was reasonably high (r=0.92), an attempt was then made to improve prediction by considering other data that do not require independent collection. These archival data included indicators of historic utilization (local Medicaid payments, the percentage of births to county residents occurring in the mothers county of residence, percentage of children immunized, and infant mortality) and services already available. Observed utilization data were obtained by surveys in eight rural counties, and the predictor was tested on three additional rural communities. A predictor equation that added to the expected utilization only one variable (the percentage of births to county residents occurring in the mothers county of residence) was found to account for approximately 95% of the variance in observed utilization. This predictor is recommended for planners who need convenient, low-cost market feasibility estimates for proposed project sites and a way to establish intermediate goals or incentives during early project development.