Skip to main content
Erschienen in: Journal of General Internal Medicine 1/2007

01.01.2007 | Original Article

The Effect of Patients’ Met Expectations on Consultation Outcomes. A Study with Family Medicine Residents

verfasst von: Roger Ruiz-Moral, Luis Ángel Pérula de Torres, Inmaculada Jaramillo-Martin

Erschienen in: Journal of General Internal Medicine | Ausgabe 1/2007

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To know the patients’ expectations and the fulfillment of these at family medicine consultations by resident doctors and to assess their effect on some consultation outcomes.

Design

A prospective cohort study.

Participants

Patients attending family medicine consultations held by 38 resident doctors: 1,301 eligible patients, 702 filled in all questionnaires.

Measurements

Before each visit, the patients’ expectations about that particular consultation were registered. Right after the visit was over, their perception of several aspects of the communicative interaction with the doctor was measured. Later, patients were interviewed on the phone to know how their expectations had been fulfilled, how satisfied they were about the consultation, how they had followed the doctor’s suggestions, if they were going to seek further care for the same cause later, and the evolution of their clinical problem. Logistic regression was the main analysis used.

Results

The most common expectations were the doctor showing interest and listening (30.5%), getting some information about the diagnosis (16.3%), and sharing problems and doubts (11.1%). The rate of main expectations that were met was 76.5%. Satisfaction with the encounter was associated with the clinical evolution [odds ratio (OR) 2.23; confidence interval (CI): 1.32–3.75], and the fulfilling of the patients’ main or two main expectations was significantly related to all the measured outcomes (satisfaction OR 3.51, CI: 1.73–7.8; adherence OR 1.80, CI: 1.11–2.92; clinical evolution OR 1.54, CI: 1.01–2.35; and seeking further care later OR 0.54, CI:0.36–0.81)

Conclusions

Patients prioritize expectations of a more general sort when they attend primary care consultations and residents fulfill these acceptably. The fulfillment of expectations seems to affect the studied outcomes more than other factors.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Kravitz R. Measuring patients’ expectations and requests. Ann Intern Med. 2001;134:881–8.PubMed Kravitz R. Measuring patients’ expectations and requests. Ann Intern Med. 2001;134:881–8.PubMed
2.
Zurück zum Zitat Williams S, Weinman J, Dale J, Newman S. Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Fam Pract. 1995;12:193–201.PubMedCrossRef Williams S, Weinman J, Dale J, Newman S. Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Fam Pract. 1995;12:193–201.PubMedCrossRef
3.
Zurück zum Zitat Kravitz R, Callahan E, Paterniti D, Antonius D, Dunham M, Lewis C. Prevalence and sources of patients’ unmet expectations for care. Ann Intern Med. 1996;125:730–7.PubMed Kravitz R, Callahan E, Paterniti D, Antonius D, Dunham M, Lewis C. Prevalence and sources of patients’ unmet expectations for care. Ann Intern Med. 1996;125:730–7.PubMed
4.
Zurück zum Zitat Hamm R, Hicks R, Bemben D. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996;43:56–62.PubMed Hamm R, Hicks R, Bemben D. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996;43:56–62.PubMed
5.
Zurück zum Zitat Marple R, Kroenke K, CR L, Wilder J, Lucas C. Concerns and expectations in patients presenting physical complaints. Arch Intern Med. 1997;157:1482–8.PubMedCrossRef Marple R, Kroenke K, CR L, Wilder J, Lucas C. Concerns and expectations in patients presenting physical complaints. Arch Intern Med. 1997;157:1482–8.PubMedCrossRef
6.
Zurück zum Zitat Peck B, Ubel P, Roter D, et al. Do unmet expectations for specific tests, referrals and new medications reduce patients’ satisfaction? J Gen Intern Med. 2004;19:1080–7.PubMedCrossRef Peck B, Ubel P, Roter D, et al. Do unmet expectations for specific tests, referrals and new medications reduce patients’ satisfaction? J Gen Intern Med. 2004;19:1080–7.PubMedCrossRef
7.
Zurück zum Zitat Kravitz R, Cope D, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visit. J Gen Intern Med. 1994;9:75–81PubMedCrossRef Kravitz R, Cope D, Bhrany V, Leake B. Internal medicine patients’ expectations for care during office visit. J Gen Intern Med. 1994;9:75–81PubMedCrossRef
8.
Zurück zum Zitat Kravitz R, Callahan E, Azari R, Antonius D, Lewis C. Assessing patients’ expectations in ambulatory medical practice. Does measurement approach make a difference? J Gen Intern Med. 1997;12:67–72.PubMedCrossRef Kravitz R, Callahan E, Azari R, Antonius D, Lewis C. Assessing patients’ expectations in ambulatory medical practice. Does measurement approach make a difference? J Gen Intern Med. 1997;12:67–72.PubMedCrossRef
9.
Zurück zum Zitat Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unsaid but not forgotten. Arch Intern Med. 2001;161:1977–84.PubMedCrossRef Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unsaid but not forgotten. Arch Intern Med. 2001;161:1977–84.PubMedCrossRef
10.
Zurück zum Zitat Jackson J, Kroenke K. The effect of unmet expectations among adults presenting physical symptoms. Ann Intern Med. 2001;134:889–97.PubMed Jackson J, Kroenke K. The effect of unmet expectations among adults presenting physical symptoms. Ann Intern Med. 2001;134:889–97.PubMed
11.
Zurück zum Zitat Thom D, Kravitz R, Bell R, Krupat E, Azari R. Patients trust in the physician relationship to patient requests. Fam Pract. 2002;19:476–83.PubMedCrossRef Thom D, Kravitz R, Bell R, Krupat E, Azari R. Patients trust in the physician relationship to patient requests. Fam Pract. 2002;19:476–83.PubMedCrossRef
12.
Zurück zum Zitat Rao J, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes. A literature review. Arch Fam Med. 2000;9:1148–55.PubMedCrossRef Rao J, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes. A literature review. Arch Fam Med. 2000;9:1148–55.PubMedCrossRef
13.
Zurück zum Zitat Peltenburg M, Fischer J, Bahrs O, van Dulmen S, van den Brink-Muinen A. The unexpected in primary care: A multicentered study on the emergence of unvoiced patient agenda. Ann Fam Med. 2004;2:534–40.PubMedCrossRef Peltenburg M, Fischer J, Bahrs O, van Dulmen S, van den Brink-Muinen A. The unexpected in primary care: A multicentered study on the emergence of unvoiced patient agenda. Ann Fam Med. 2004;2:534–40.PubMedCrossRef
14.
Zurück zum Zitat Peck B, Asch D, Goold S, et al. Measuring patient expectations. Does the instrument affect satisfaction or expectations? Med Care. 2001;39:100–8.PubMedCrossRef Peck B, Asch D, Goold S, et al. Measuring patient expectations. Does the instrument affect satisfaction or expectations? Med Care. 2001;39:100–8.PubMedCrossRef
15.
Zurück zum Zitat Zebiene E, Razgauskas E, Basys V, et al. Meeting patient’s expectations in primary care consultation in Lithuania. Int J Qual Health Care. 2004;16:83–9.PubMedCrossRef Zebiene E, Razgauskas E, Basys V, et al. Meeting patient’s expectations in primary care consultation in Lithuania. Int J Qual Health Care. 2004;16:83–9.PubMedCrossRef
16.
Zurück zum Zitat Froehlich G, Weich G. Meeting walk-in patients’ expectations for testing. J Gen Intern Med. 1996;11:470–4.PubMedCrossRef Froehlich G, Weich G. Meeting walk-in patients’ expectations for testing. J Gen Intern Med. 1996;11:470–4.PubMedCrossRef
17.
Zurück zum Zitat Himmel W, Lippert-Urbanke E, Kochen M. Are patients more satisfied when they receive a prescription? The effect of expectations in general practice. Scand J Prim Health Care. 1997;15:118–22.PubMedCrossRef Himmel W, Lippert-Urbanke E, Kochen M. Are patients more satisfied when they receive a prescription? The effect of expectations in general practice. Scand J Prim Health Care. 1997;15:118–22.PubMedCrossRef
18.
Zurück zum Zitat Uhlmann R, Inui T, Pecorato R, Carter W. Relationship to patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependence diabetes. J Gen Intern Med. 1988;3:458–63.PubMedCrossRef Uhlmann R, Inui T, Pecorato R, Carter W. Relationship to patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependence diabetes. J Gen Intern Med. 1988;3:458–63.PubMedCrossRef
19.
Zurück zum Zitat Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unmet expectations for care and the patient–physician relationship. J Gen Intern Med. 2002;17:817–24.PubMedCrossRef Bell R, Kravitz R, Thom D, Krupat E, Azari R. Unmet expectations for care and the patient–physician relationship. J Gen Intern Med. 2002;17:817–24.PubMedCrossRef
20.
Zurück zum Zitat Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315:1211–4.PubMed Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315:1211–4.PubMed
21.
Zurück zum Zitat Jackson J, Kroenke K, Chamberlin J. Effects of physician awareness of symptom-related expectations and mental disorders. Arch Fam Med. 1999;8:135–42.PubMedCrossRef Jackson J, Kroenke K, Chamberlin J. Effects of physician awareness of symptom-related expectations and mental disorders. Arch Fam Med. 1999;8:135–42.PubMedCrossRef
22.
Zurück zum Zitat Kravitz R, Bell R, Azari R, Krupat E, Kelly-Reif S, Thom D. Request fulfillment in office practice: antecedents and relationship to outcomes. J Gen Intern Med. 2002;40:38–51. Kravitz R, Bell R, Azari R, Krupat E, Kelly-Reif S, Thom D. Request fulfillment in office practice: antecedents and relationship to outcomes. J Gen Intern Med. 2002;40:38–51.
23.
Zurück zum Zitat Kaplan S, Greenfield S, Ware J. Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S111–127. Kaplan S, Greenfield S, Ware J. Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S111–127.
24.
Zurück zum Zitat Kinmonth A, Woodcock A, Griffin S, Spiegal N, Campbell M, on behalf of the Diabetes Care from Diagnosis Research Team. Randomised controlled trial of patient centred care of diabetes in general practice: impact on current well-being and future disease risk. BMJ. 1998;317:1202–8.PubMed Kinmonth A, Woodcock A, Griffin S, Spiegal N, Campbell M, on behalf of the Diabetes Care from Diagnosis Research Team. Randomised controlled trial of patient centred care of diabetes in general practice: impact on current well-being and future disease risk. BMJ. 1998;317:1202–8.PubMed
25.
Zurück zum Zitat Sanchez-Menegay C, Hudes E, Cummings S. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432–4.PubMedCrossRef Sanchez-Menegay C, Hudes E, Cummings S. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432–4.PubMedCrossRef
26.
Zurück zum Zitat Junod Perron N, Secretan F, Vannotti M, Pecoud A, Favrat B. Patient expectations at a multicultural out-patient clinic in Switzerland. Fam Pract. 2003;20:428–33.CrossRef Junod Perron N, Secretan F, Vannotti M, Pecoud A, Favrat B. Patient expectations at a multicultural out-patient clinic in Switzerland. Fam Pract. 2003;20:428–33.CrossRef
27.
Zurück zum Zitat Sánchez-Menegay C, Stalder H. Do physicians take into account patients’ expectations? J Gen Intern Med. 1994;9:404–6.PubMedCrossRef Sánchez-Menegay C, Stalder H. Do physicians take into account patients’ expectations? J Gen Intern Med. 1994;9:404–6.PubMedCrossRef
28.
Zurück zum Zitat Cabré Vila J, Ortega Vila Y, Vila Córcoles A, Guillén López A, Checa Webber E, Farré Guasch J. ¿Qué espera el paciente de su médico de familia cuando acude habitualmente a su consulta? (What do patients expect from their family doctors when they go to their consultation on a regular basis?) Aten Primaria 1999;24:403–4. Cabré Vila J, Ortega Vila Y, Vila Córcoles A, Guillén López A, Checa Webber E, Farré Guasch J. ¿Qué espera el paciente de su médico de familia cuando acude habitualmente a su consulta? (What do patients expect from their family doctors when they go to their consultation on a regular basis?) Aten Primaria 1999;24:403–4.
29.
Zurück zum Zitat Palacio Lapuente F, Marquet Palomer R, Oliver Esteve A, Castro Guardiola P, Bel Reverter M, Piñol Moreso J. Las expectativas de los pacientes: ¿qué aspectos valoran en un centro de salud? Un estudio cualicuantitativo. (Patients’ expectations: what aspects do they value in a health centre? A quali-quantitative study). Aten Primaria 2003;31:307–14.PubMedCrossRef Palacio Lapuente F, Marquet Palomer R, Oliver Esteve A, Castro Guardiola P, Bel Reverter M, Piñol Moreso J. Las expectativas de los pacientes: ¿qué aspectos valoran en un centro de salud? Un estudio cualicuantitativo. (Patients’ expectations: what aspects do they value in a health centre? A quali-quantitative study). Aten Primaria 2003;31:307–14.PubMedCrossRef
30.
Zurück zum Zitat Deveugele M, Derese A, van der Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross-sectional study in six European countries. BMJ. 2002;325:472–7.PubMedCrossRef Deveugele M, Derese A, van der Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross-sectional study in six European countries. BMJ. 2002;325:472–7.PubMedCrossRef
31.
Zurück zum Zitat Seguí Díaz M, Linares Pou L, Blanco López W, Ramos Aleixades J, Torrent Quetglás M. Tiempos durante la visita médica en atención primaria.(Length of medical visits in primary care) Aten Primaria 2004;33:496–502.PubMedCrossRef Seguí Díaz M, Linares Pou L, Blanco López W, Ramos Aleixades J, Torrent Quetglás M. Tiempos durante la visita médica en atención primaria.(Length of medical visits in primary care) Aten Primaria 2004;33:496–502.PubMedCrossRef
32.
Zurück zum Zitat Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Evolución del perfil comunicacional de los médicos residentes de medicina de familia. (Evolution of the communicative profile of family medicine trainees) Aten Primaria 2002;29:132–44.PubMed Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Evolución del perfil comunicacional de los médicos residentes de medicina de familia. (Evolution of the communicative profile of family medicine trainees) Aten Primaria 2002;29:132–44.PubMed
33.
Zurück zum Zitat Ruiz Moral R, Parras Rejano J, Alcalá Partera J, Castro Marín E, Pérula de Torres L. ¿Bienvenido y hasta luego u hola y adiós?: conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas. (Welcome and so long or hello and goodbye? Communicative behaviours of resident doctors at the beginning and end of consultations). Aten Primaria 2005;36:537–44.PubMedCrossRef Ruiz Moral R, Parras Rejano J, Alcalá Partera J, Castro Marín E, Pérula de Torres L. ¿Bienvenido y hasta luego u hola y adiós?: conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas. (Welcome and so long or hello and goodbye? Communicative behaviours of resident doctors at the beginning and end of consultations). Aten Primaria 2005;36:537–44.PubMedCrossRef
34.
Zurück zum Zitat Ruiz-Moral R, Perez Rodriguez E, Perula de Torres L, Torre de la Torre J. Physician–patient communication: a study on the observed behaviours of specialty physicians and the ways their patients perceive them. Patient Educ Couns 2006 doi:10.1016/j.pec.2006.02.010 (in press). Ruiz-Moral R, Perez Rodriguez E, Perula de Torres L, Torre de la Torre J. Physician–patient communication: a study on the observed behaviours of specialty physicians and the ways their patients perceive them. Patient Educ Couns 2006 doi:​10.​1016/​j.​pec.​2006.​02.​010 (in press).
35.
Zurück zum Zitat Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Effectiveness of a clinical interviewing training program for family practice residents: a randomized controlled trial. Fam Med. 2003;35:489–95. Ruiz Moral R, Rodríguez Salvador J, Pérula de Torres L, Prados Castillejo J. Effectiveness of a clinical interviewing training program for family practice residents: a randomized controlled trial. Fam Med. 2003;35:489–95.
36.
Zurück zum Zitat Levy-Storms L, Schnelle J, Simmons S. A comparison of methods to assess nursing home residents’ unmet needs. Gerontologist. 2002;42:454–61.PubMed Levy-Storms L, Schnelle J, Simmons S. A comparison of methods to assess nursing home residents’ unmet needs. Gerontologist. 2002;42:454–61.PubMed
37.
Zurück zum Zitat Levy-Storms L, Simmons S, Gutierrez V, Miller-Martínez D, Hickey K, Schnelle J. A refined protocol for coding nursing home residents’ comments during satisfaction interviews. J Gerontol B Psychol Sci Soc Sci. 2005;60:S326–330.PubMed Levy-Storms L, Simmons S, Gutierrez V, Miller-Martínez D, Hickey K, Schnelle J. A refined protocol for coding nursing home residents’ comments during satisfaction interviews. J Gerontol B Psychol Sci Soc Sci. 2005;60:S326–330.PubMed
38.
Zurück zum Zitat Webb S, Lloyd M. Prescribing and referral in general practice: a study of patients’ expectations and doctors’ actions. Br J Gen Pract. 1994;44:165–9.PubMed Webb S, Lloyd M. Prescribing and referral in general practice: a study of patients’ expectations and doctors’ actions. Br J Gen Pract. 1994;44:165–9.PubMed
39.
Zurück zum Zitat Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations—a questionnaire study. BMJ. 1997;315:520–3.PubMed Cockburn J, Pit S. Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations—a questionnaire study. BMJ. 1997;315:520–3.PubMed
40.
Zurück zum Zitat Stewart M, Brown J, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.PubMed Stewart M, Brown J, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.PubMed
41.
Zurück zum Zitat Little P, Everitt H, Williamson I, et al. Observational study on the effect of patient centeredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908–11.PubMedCrossRef Little P, Everitt H, Williamson I, et al. Observational study on the effect of patient centeredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908–11.PubMedCrossRef
Metadaten
Titel
The Effect of Patients’ Met Expectations on Consultation Outcomes. A Study with Family Medicine Residents
verfasst von
Roger Ruiz-Moral
Luis Ángel Pérula de Torres
Inmaculada Jaramillo-Martin
Publikationsdatum
01.01.2007
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 1/2007
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-007-0113-8

Weitere Artikel der Ausgabe 1/2007

Journal of General Internal Medicine 1/2007 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.