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. 2011 Nov;85(2):173-9.
doi: 10.1016/j.pec.2010.09.017. Epub 2010 Oct 28.

Patient-physicians' information exchange in outpatient cardiac care: time for a heart to heart?

Urmimala Sarkar  1 , Dean Schillinger, Kirsten Bibbins-Domingo, Anna Nápoles, Leah Karliner, Eliseo J Pérez-Stable
Affiliations

Patient-physicians' information exchange in outpatient cardiac care: time for a heart to heart?

Urmimala Sarkar et al. Patient Educ Couns. 2011 Nov.

Abstract

Objective: Agreement between patients and physicians is an indicator of successful communication. Concordance in domains of communication among patients with heart disease and communication barriers has not been studied.

Methods: English, Spanish, or Cantonese-speaking patients seen at a public hospital cardiology clinic were assessed with pre-visit questionnaires. Surveys of patients and their physicians immediately after the visit asked each about: (1) cardiac functional status, (2) barriers to self-management, (3) cardiac diagnoses, and (4) treatment. We assessed patient-physician concordance in these domains.

Results: 179 patients and 56 physicians completed the study. Patients had low educational attainment, limited literacy and limited English proficiency. Physicians underestimated patients' cardiac functioning status (NYHA Classes 2-4), by 1 class or more in 50% of visits. Physicians were frequently unaware of medication (38/57, 67%) and psychosocial (61/88, 69%) barriers. Patients were unable to describe even 1 matching diagnosis (72/170, 42% concordant) among 5 categories. Physicians' reported medication changes in 106/179 (59%) but patients failed to report these changes in 55% (58/106). Multivariate logistic regression analyses showed no significant association between patient characteristics and concordance.

Conclusion: Patients and physicians often fail to communicate effectively and determinants of concordance in CVD care require further investigation.

Practice implications: Developing strategies to improve communication within the medical encounter are critical to improving ambulatory chronic disease management.

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Figures

Figure 1
Figure 1
Conceptual Model of Patient-Provider Communication in the Ambulatory Encounter
Figure 2
Figure 2
Patient-physician concordance on degree of cardiac symptoms, N=179
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