Journal of general internal medicine
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Comparative Study
Race/ethnicity and patient satisfaction. Using the appropriate method to test for perceived differences in care.
To determine whether an established patient satisfaction scale commonly used in the primary care setting is sufficiently sensitive to identify racial/ethnic differences in satisfaction that may exist; to compare a composite indicator of overall patient satisfaction with a 4-item satisfaction scale that measures only the quality of the direct physician-patient interaction. ⋯ Measurements of patient satisfaction that use multi-item, composite indicators should also include focused comparisons of satisfaction directly with the care provided by the physician. In measurements of patient satisfaction, patient race/ethnicity should be included as an explanatory variable. The results also confirm earlier findings that factors external to the direct physician-patient interaction can have substantial effects on patients' perceptions of that interaction.
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Despite the explosion of online communication in the community, its use between patients and their health care providers remains low. However, rapidly growing patient and provider interest in using online communication has motivated organizations to consider options for deploying these new tools in clinical practice. ⋯ Finally, we provide a roadmap for developing and deploying these new tools in clinical practice. Health care providers and their organizations will need to consider issues related to technology, data management, operations, communication management, and financial support in order to successfully deploy online services and communication for patients in clinical settings.
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Multicenter Study Clinical Trial
Promoting advance directives among elderly primary care patients.
To determine efficient ways of promoting advance directives among heterogeneous populations of elderly ambulatory patients. ⋯ A replicable intervention largely targeting doctors achieved a modest increase in advance directives among elderly ambulatory patients. Future interventions may need to target lower-income patients, "younger" elderly, and more specifically address doctors' attitudes and comfort discussing advance directives.
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Physician self-disclosure has been viewed either positively or negatively, but little is known about how patients respond to physician self-disclosure. ⋯ Physician self-disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self-disclosure is either well or poorly received.
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Multicenter Study Comparative Study
Race and patient refusal of invasive cardiac procedures.
To determine whether patients' decisions are an important determinant of nonuse of invasive cardiac procedures and whether decisions vary by race. ⋯ Patient decisions to decline recommended invasive cardiac procedures were infrequent and may explain only a small fraction of racial disparities in the use of invasive cardiac procedures.