Biomaterial Database

Health promotion in primary care: physician-patient communication and decision making about prescription medications. 1995

G Makoul, and P Arntson, and T Schofield

Department of Medicine, Northwestern University Medical School, Chicago, Illinois, USA.

To examine health promotion in a primary-care context, we studied perceived and actual communication in 271 consultations between general practitioners and patients in Oxford (England). Although health promotion is a term usually reserved for public-health or wellness programs, a health promotion perspective enriches the examination of communication in physician-patient interactions by emphasizing issues of empowerment, competence and control. Accordingly, we are interested in how communication during medical encounters can improve patients' abilities to exercise appropriate control over their health. A major factor in enabling patients to increase control over their health involves developing their competencies for making decisions and enacting behaviors that can lead to desired, and attainable, health outcomes. This report focuses on communication and decision making about prescription medications, since whether and how to use medications are among the most common and important decisions in which patients can participate. Five instruments were employed to collect data about physicians, patients and their consultations: a Video Analysis, which allowed assessment of actual communication behavior; a Patient Questionnaire designed to gauge perceptions of the encounter and collect demographic information; a Medical-Record Review, which provided information on utilization, diagnosis and treatment; a Telephone Interview, conducted 14 days after the consultation to obtain follow-up information (e.g. experience with the prescribed medication); and a Doctor Questionnaire that focused on attitudes toward consultations and patients. With respect to communication about prescription medications, physicians most frequently mentioned product name (78.2% of consultations) and instructions for use (86.7% of consultations). Patients were extremely passive, rarely offering their opinion or initiating discussion about any aspect of the treatment. We suggest that improving patients' decision-making competencies may require more discussion of benefits and risks, as well as discussion of patients' opinions about the prescribed medications and their abilities to follow through with the treatment plans. The research design proved useful in highlighting discrepancies between perceived and actual communication. Physicians tended to overestimate the extent to which they discussed patients' ability to follow the treatment plan, elicited patients' opinion about the prescribed medication and discussed risks of the medication. And, 24.3% of the patients left the consultation with an 'illusion of competence', a belief that important topics had been discussed when, in fact, they had not been mentioned at all. The pattern of results illustrates the complexity of health promotion in primary care, and underscores the importance of attending to both perceived and actual communication in medical encounters.

UI	MeSH Term	Description	Entries
D007223	Infant	A child between 1 and 23 months of age.	Infants
D007389	Internal-External Control	Personality construct referring to an individual's perception of the locus of events as determined internally by his or her own behavior versus fate, luck, or external forces. (ERIC Thesaurus, 1996).	Locus of Control,External-Internal Control,Sense of Control,Control Locus,Control, External-Internal,Controls, External-Internal,Controls, Internal-External,Internal-External Controls
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D010353	Patient Education as Topic	The teaching or training of patients concerning their own health needs.	Education of Patients,Education, Patient,Patient Education
D010358	Patient Participation	Patient involvement in the decision-making process in matters pertaining to health.	Patient Activation,Patient Empowerment,Patient Engagement,Patient Involvement,Patient Participation Rates,Activation, Patient,Empowerment, Patient,Engagement, Patient,Involvement, Patient,Participation Rate, Patient,Participation Rates, Patient,Participation, Patient,Patient Participation Rate
D010817	Physician-Patient Relations	The interactions between physician and patient.	Doctor-Patient Relations,Doctor Patient Relations,Physician Patient Relations,Physician Patient Relationship,Doctor Patient Relation,Doctor-Patient Relation,Physician Patient Relation,Physician Patient Relationships,Physician-Patient Relation,Relation, Doctor Patient,Relation, Doctor-Patient,Relation, Physician Patient,Relation, Physician-Patient,Relations, Doctor Patient,Relations, Doctor-Patient,Relations, Physician Patient,Relations, Physician-Patient,Relationship, Physician Patient,Relationships, Physician Patient
D010865	Pilot Projects	Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work.	Pilot Studies,Pilot Study,Pilot Project,Project, Pilot,Projects, Pilot,Studies, Pilot,Study, Pilot
D011320	Primary Health Care	Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)	Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D002648	Child	A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL.	Children