Development of a psychosocial concern index from videotaped interviews of nurse practitioners and family physicians.

The delivery of primary health care involves a complex interactive process between the provider and patient. One important feature of this interaction is provider concern for psychosocial issues. A study was undertaken to examine provider's actions with the patient and to describe the factors influencing the provider's concern with psychosocial issues. A total of 412 provider-patient clinic visits, including 276 with physicians and 136 with nurse practitioners, were videotaped and analyzed using a provider psychosocial concern index developed specifically for this study. Data from exit and follow-up interviews with patients plus a provider questionnaire were analyzed to identify factors associated with a provider's psychosocial concern. The results show that an interactional analysis focusing on clinician activities can be useful in describing important process-outcome relationships such as psychosocial concern. Factors such as type of visit, visit history, type of provider, and sex of patient and provider were associated with the amount of psychosocial concern displayed by providers and perceived by patients.