Physician & Patient Perceptions of Physician Knowledge about Patient Information during Primary Care Visits Paul Smith 2, Molly Snellman 3, Brian Arndt 2, John Beasley 2, Roger Brown 4, Mary Ellen Hagenauer 6, Kate Judge 2, Jamie Stone 5,6, Bentzi Karsh 6, Tosha Wetterneck 1 1 Department of Medicine, 2 Department of Family Medicine University of Wisconsin (UW) School of Medicine and Public Health; 3 UW Medical Foundation; 4 School of Nursing, 5 School of Pharmacy, 6 Department of Industrial and Systems Engineering, UW-Madison, WI  Physicians often perceive they are missing important clinical information at the end of elderly primary care visits  Patients & physicians agree on how much information the physician had ½ to ¾ of visits  Patients have valuable info that physicians do not have 4-19% of the time, esp. about other health professional visits & the concerns about costs of care  Strategies are needed to get physicians the information they need before elderly primary care visits  Pre-visit planning intervention underway Introduction Results  Patient info availability during elderly primary care visits is a safety issue  Scant primary care research on patient & physician perceptions of safety of care & congruency of perceptions  Knowledge of discrepancies is useful to improve the safety and patient centeredness Methods Conclusions Study design  Randomized controlled trial of a pre-visit planning intervention  Pre-data collection: April – December 2011 Setting & Participants  4 Primary care clinics in Southwest/Central WI  16 primary care physicians, 4 per clinic  patients age 65 or older per physician Patient Characteristics Research Goal  Determine congruency of perceptions btw physicians & elderly patients of physician knowledge of patient information during a primary care visit. # Patients755 Mean age, years76 Female (%)63 % w/ Chronic health conditions 91% 1, 61% >= 2 Grant support: Agency for Healthcare Research & Quality R01, PI: Karsh / Wetterneck Table 1: Congruency Between Patient and Doctor Responses (P=Patient, D=Doctor) % of Responses in Each CategoryP = D Ideal StateP > DP < D Questionn (visits) Same Score P = D = 6,7 Patient Score Higher Patient Score Lower P value 1.Knowledge about ongoing medical problems 700 P 2%13%85% 57%53%34%8%0.000 D 5%34%61% 2. Have all the information needed 704 P 0%12%88% 70%66%23%8%0.000 D 3%24%73% 3. Knowledge about visits to other health professionals 638 P 3%18%80% 72%68%13%15%0.000 D 3%15%82% 4. Knowledge about results of tests and procedures 681 P 2%11%87% 76%74%15%10%0.000 D 3%14%83% 5. Knowledge about medications705 P 1%7%92% 77%76%16%7%0.001 D 3%15%83% 6. Knowledge about care and medication cost concerns 563 P 5%17%78% 67%65%14%19%0.001 D 2%16%83% 7. Knowledge about health concerns 700 P 1%10%89% 52%48%42%6%0.000 D 8%38%54% 8. Knowledge about main reason for visit 705 P 1%7%93% 65%63%32%4%0.000 D 5%29%66% Survey questionnaire  Post-visit survey for doctors & patients:  8 Q’s: how much patient info was available for visit  Example: P: Did this doctor have all the information he or she needed for the visit? D: Was there information missing from today’s visit?  Question scale: 1=None, 2 = A little, 3 = Some, 4 = Moderately, 5 = Pretty Much, 6 = Very Much, 7 = Completely  For over 1/3 of visits, doctors did not have good info on main reason for visit, health concerns, & ongoing medical problems  Doctors & patients agreed about info availability 48-76% of time  Least: health concerns  Most: tests/procedures  Patients thought their doctor had more information than their doctor did for 6 of 8 of the measures  Dramatic for all info needed, ongoing medical prob, health concerns & main visit reason  Patients thought their doctor had less information than their doctor did for 2 of 8 measures  Concerns about costs of care & visits to other health professionals Analysis  Responses grouped into 3 info availability categories: 1-2 (low), 3-5 (medium), & 6-7 (high)  Descriptive statistics used to calculate % response in each category for physicians & patients and congruency of response category for each visit  Chi-square used to compare response congruency btw physicians & patients for each visit