Study Explores Patient Priorities in Primary Care Consultations

Primary care physicians, like all health care professionals, are encouraged to deliver patient-centered services that respond to what patients want and need. But what attributes do patients value most in primary care consultations? Researchers in the United Kingdom's National Primary Care Research and Development Centre at the University of Manchester and University of York explored that question in a study reported on in the March/April Annals of Family Medicine.

"If service delivery is to be acceptable to patients, policy-makers need to understand patients' priorities," the researchers write. "The published literature does not clearly define the relative importance patients place on attributes such as technical and interpersonal care."

The study assessed patients' priorities for a range of attributes of primary care consultations, including access, technical care (i.e., the quality of clinical care), continuity, and attributes relevant to patient-centered care. Although patients in the United Kingdom don't pay for health care services at the point of delivery, the researchers included a cost attribute to assess how much patients would be willing to pay for each attribute. This was done to assess perceived value.

The researchers' analyses were based on responses from 1,193 patients in six family practices in England. The study found that overall, patients would be willing to pay the most for a thorough physical exam ($40.87), followed by a doctor who knows them well ($12.18).

Patient-centered attributes (e.g., a doctor who is interested in the patient's ideas, who asks about social and emotional well-being, and who involves the patient in decision-making) scored well, but they ranked below the top two attributes. Patients indicated they would be willing to pay from $12.06 to $14.82 for these attributes.

"Although patient-centered care is important to patients, they may place higher priority on the technical quality of care and continuity of care," the authors conclude.

Other attributes of care patients in the study indicated they would be willing to pay for were

"Overall, our results provide health policy-makers with a comprehensive assessment of patients' priorities together with a useful financial measure of their relative value," the authors write. "These results can inform discussions about issues such as pay-for-performance and the balance to be struck between incentives for technical and nontechnical aspects of care."

According to the authors, information provided to patients about practices and physicians to help them make decisions should include information on both technical and interpersonal aspects of care. However, they note, providing information about the quality of technical care is challenging because "conventional clinical indexes of quality may not meet the needs of patients."

The authors also comment on the finding that patients placed a greater value on continuity -- a physician who knew them well -- than they did on patient-centered attributes. "Our results are in line with those of published studies that suggest that continuity is important," the authors write. "But they extend that work to show that patients still prioritize continuity even when offered a trade with patient-centeredness, which suggests that a reduction in continuity of care could not simply be overcome by professionals with better communication skills."