Improving Patient Care

Focus on the Family, Part II: Does a Family Focus Affect Patient Outcomes?

By being aware of the strengths and limitations of your family focus style, you can help preserve the family in "family practice."

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Robin S. Gotler, MA, Jack H. Medalie, MD, MPH, Stephen J. Zyzanski, PhD, George E. Kikano, MD, Kurt C. Stange, MD, PhD

A focus on the family is one of the unique characteristics of family practice. As reported in the previous article in this series, the Direct Observation of Primary Care (DOPC) Study found that family physicians have two different approaches to focusing on the family.¹ Physicians with a "family history style" use family information as background in caring for individual patients but do not delve deeply into family problems. Physicians with a "family orientation style" view the family as the unit of care, seeing multiple members of the same family, using a family chart and addressing family issues during patient visits. But does a physician's style of focusing on the family make a difference in patient outcomes?

Study results

To explore that question, we examined data from the DOPC Study, which sought to understand the content of family practice through direct observation of 4,454 patient visits to 138 family physicians in Northeast Ohio. The study found that when either of the family focus styles were used, patients were similarly satisfied with the visit and rated their physicians similarly when asked about coordination of care, interpersonal communication and whether they sensed that they could go to the physician for almost any problem.² However, physicians with a "family orientation style" spent more time in the visit gathering family information and were rated more highly by patients on knowing their history, health needs and values. In contrast, physicians with a "family history style" had longer visits (approximately 1.5 minutes longer, on average) and spent more time delivering preventive services, resulting in significantly higher preventive service rates.

Take-away lessons

These findings suggest that there are trade-offs between the different approaches to focusing on the family. A "family orientation style," in which physicians get to know patients in their family and social contexts, may be important in helping patients address behavioral changes, major life events and serious illnesses. A "family history style," which focuses on individuals and their medical histories, appears to foster the delivery of necessary preventive services, perhaps by using knowledge of familial risk factors as a context for patient care.

These trade-offs between the two family focus styles underscore the competing time demands and opportunities that are part of meeting a wide range of patient needs in the family practice setting. By being aware of the strengths and limitations of their family focus styles, and by trying to find other ways to meet those patient needs that their own practice styles do not address, family physicians can help make "the family in family practice" a reality in today's chaotic health care environment.

Illuminating the 'Black Box' of Primary Care This article continues our series offering practical lessons from the Direct Observation of Primary Care (DOPC) Study, which was funded by the National Institutes of Health and conducted by the Center for Research in Family Practice and Primary Care, with support from the AAFP. The study demonstrates the complexities of the patient visit, the demands of real-world practice and the value of primary care, issues that policymakers, the public and even clinicians have not fully understood. Researchers used a multi-method approach, including direct observation, to study 4,454 patient visits to 138 family physicians in 84 practice sites.

Robin Gotler is project coordinator in the Family Medicine Research Division of Case Western Reserve University/University Hospitals of Cleveland (CWRU/UHC). Dr. Medalie is an emeritus professor of family medicine at CWRU/UHC. Dr. Zyzanski is a professor of family medicine at CWRU/UHC. Dr. Kikano is an associate professor and acting chairman of family medicine at CWRU/UHC. Dr. Stange is a professor of family medicine, epidemiology and biostatistics, oncology and sociology at CWRU/UHC. He is also director of the Center for Research in Family Practice and Primary Care, one of three family practice research centers funded by the AAFP.

1. Gotler RS, Medalie JH, Zyzanski SJ, et al. Focus on the family, part I: What is your family focus style? Fam Pract Manage. March 2001:49-50.
2. Medalie JH, Zyzanski SJ, Goodwin MA, Stange KC. Two physician styles of focusing on the family: Their relation to patient outcomes and process of care. J Fam Pract. 2000;49(3):209-215.

Copyright © 2001 by the American Academy of Family Physicians.
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