From the Department of Internal Medicine(ECS), Division of Research (MTV, CSU, RWG), Kaiser Permanente Northern California, Oakland, CA.
J Am Board Fam Med. 2019 Jul-Aug;32(4):513-520. doi: 10.3122/jabfm.2019.04.180380.
Primary care providers (PCPs) are often challenged to address multiple patient concerns during time-limited visits. The need for PCPs to limit the number of issues addressed may have a negative impact on discussion of patient-defined visit priorities.
Using data from a recent clinical trial (Aligning Patients and Providers, ClinicalTrials.gov: NCT02707146), we examined the association between patient-defined visit priorities and subsequent provider actions taken during and after the visit. We tested the hypothesis that psychosocial concerns (eg, stress, anxiety, caregiving demands) are less likely to be addressed than traditional medical concerns.
We analyzed 147 patient-defined visit priorities submitted just before the visit by 109 patients (mean age, 59.0 ± 12.7 years; including 73.4% women, 47.7% non-White race/ethnicity). Nearly one quarter of patient-defined visit priorities were related to psychosocial concerns (35/147; 23.8%). In models adjusting for age, gender, race/ethnicity, and familiarity with PCP, patients' psychosocial priorities were significantly less likely than medical priorities to be addressed during the visit (63% vs. 88%; adjusted odds ratio [aOR], 0.16; 95% CI, 0.06 to 0.41; < .001), to receive clinical action (51% vs. 82%; aOR, 0.15; 95% CI, 0.06 to 0.38; < .001), or to receive post visit information from the primary care doctor (17% vs. 32%; aOR, 0.39; 95% CI, 0.14 to 1.08; = .07).
Patient-defined psychosocial priorities are less likely to be addressed during (or immediately after) primary care visits compared with patient-defined medical priorities.
初级保健提供者（PCP）在限时就诊期间经常面临解决多个患者关注问题的挑战。PCP 需要限制解决问题的数量，这可能会对讨论患者定义的就诊重点产生负面影响。
利用最近临床试验（Aligning Patients and Providers，ClinicalTrials.gov：NCT02707146）的数据，我们研究了患者定义的就诊重点与就诊期间和之后随后的提供者行动之间的关联。我们检验了以下假设，即心理社会问题（例如，压力、焦虑、照护需求）不太可能得到解决，而不是传统的医疗问题。
我们分析了 109 名患者在就诊前提交的 147 项患者定义的就诊重点（平均年龄为 59.0±12.7 岁；包括 73.4%女性，47.7%非白人种族/族裔）。近四分之一的患者定义的就诊重点与心理社会问题有关（35/147；23.8%）。在调整年龄、性别、种族/族裔和与 PCP 熟悉程度的模型中，患者的心理社会重点在就诊期间得到解决的可能性明显低于医疗重点（63%对 88%；调整后的优势比[aOR]，0.16；95%置信区间[CI]，0.06 至 0.41；<0.001），获得临床行动（51%对 82%；aOR，0.15；95%CI，0.06 至 0.38；<0.001），或从初级保健医生那里获得就诊后信息（17%对 32%；aOR，0.39；95%CI，0.14 至 1.08；=0.07）。
与患者定义的医疗重点相比，患者定义的心理社会重点在初级保健就诊期间（或就诊后立即）得到解决的可能性较小。
