PubMed · 10289013
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P J Kenkel. 1988-08-26. New programs target outpatient utilization.. https://pubmed.ncbi.nlm.nih.gov/10289013/
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BACKGROUND: Patient-centered clinical methods encourage physicians to explore the patient's reasons for the visit. Practitioners worry that this behavior may be inefficient. This study piloted a method to examine how the number of problems managed and time per problem vary with time spent exploring a patient's views. METHODS: Exploration of a patient's views, medical investigation, explanation, and management were mapped against time for a defined agenda from videotapes of eight second-year residents seeing three simulated patients. Performance of three of four tasks defined completion of work on an agendum. Visit length, time per agendum completed, and proportion of agenda completed were compared with time per task using regression methods. RESULTS: Time on exploration correlated with visit length and proportion of agenda completed, but other tasks did not. Time per agendum completed was unrelated to time on exploration. CONCLUSIONS: Visits were longer when more time was spent exploring the patient's reason for the visit because the physician tackled more problems. Time required per problem was not significantly increased. Task/agenda mapping is worth further development to examine differences in comprehensiveness and efficiency among practice styles.
OBJECTIVE: 1) To develop experimentally a method of detecting quality problems in primary care, based on the patient's analysis of his/her overall health-care experience. 2) To perceive and assimilate, from the point of view of the providers, aspects of care related to patients' expectations. DESIGN: A descriptive concurrent study in which "user-doctors" visit their general practitioners as patients. SETTING: Health centres, located in Aragón and Rioja. PARTICIPANTS: Thirty-two doctors doing a doctorate. INTERVENTION: Filling-out of a semi-structured questionnaire and individual elaboration of a report analysing the different care stages: appointment, waiting, visit and referrals. Main variables of the study: accessibility, waiting time, comfort, doctor's interest, quality of information, satisfaction, treatment received. For each stage, in line with prior expectations, the detection of problems, the search for positive aspects and the analysis of the care situation with corrective measures were proposed. MEASUREMENTS AND MAIN RESULTS: Problems detected: difficulty of telephone contact, uncomfortable and lengthy wait, health staff smoking, scant interest from the doctor, no greeting on entry, interruptions during the visit, insufficient information. Positive aspects: facilities in choice of appointment, cordiality of treatment, personal call by the doctor, punctuality. CONCLUSIONS: The method is simple, economical, sensitive in detecting problems felt by the users, and feasible as a complement to other systems used in our ambit.