 |
|
Visit-Specific Expectations and Patient-Centered Outcomes
A Literature Review
Jaya K. Rao, MD, MHS;
Morris Weinberger, PhD;
Kurt Kroenke, MD
Arch Fam Med. 2000;9:1148-1155.
ABSTRACT
| |
Background Primary care patients often have certain expectations when visiting physicians, many of which may be undetected. These unmet expectations can affect outcomes such as satisfaction with care. We performed a formal literature review to examine the effect of fulfillment of patients' visit-specific expectations on their satisfaction as well as on health status and compliance.
Patients and Methods Included studies were conducted in primary care settings, systematically recruited patients, elicited previsit and/or postvisit expectations relative to specific visits, and measured patient-centered outcomes. Two reviewers abstracted information on study characteristics; types, timing, and method of expectation ascertainment; and outcomes. Disagreements were resolved by consensus.
Results Twenty-three studies were reviewed including 7 trials, 4 cohort studies, and 12 cross-sectional studies. Patients frequently expected information rather than specific physician actions, but physicians often did not accurately perceive patients' visit-specific expectations. In 19 studies that assessed postvisit patient satisfaction, a positive association between meeting patient expectations and overall satisfaction was demonstrated in 11 studies, inconclusive in 3, and not established in 5. In 2 studies assessing physician satisfaction, physicians with access to patients' expectations were more satisfied than those without access. Other outcomes (symptom or disease improvement, health status, test ordering, health care costs, psychological symptoms) were measured in only a few studies, and the results were inconclusive.
Conclusions Addressing patients' visit-specific expectations appears to affect satisfaction to a modest degree. Future studies should evaluate methods that efficiently elicit, prioritize, and provide patients' previsit expectations for physicians and should examine the longitudinal effect of expectation fulfillment on patient outcomes.
INTRODUCTION
NATIONALLY, health care systems and physicians have been encouraged to consider the patient's perspective when delivering health care. Among the incentives driving this process is a growing recognition of the importance of patient-centered outcomes, such as satisfaction and quality of life, as health care markets compete for patients.1-2 Dissatisfied patients are less likely to comply with medical advice, to follow up with appointments, and to show symptom improvement,3 and they are more likely to change health care systems or physicians.4-7
Whereas certain patient-centered outcomes (such as health-related quality of life and compliance) may be more directly influenced by a combination of disease-, patient-, or physician-related factors, outcomes such as satisfaction appear to be influenced by both clinical and nonclinical factors. For example, nonclinical influences may include the cleanliness of the clinic, timeliness of appointments, or the friendliness of the nonclinical office staff. Other more physician-specific components include the physician's ability to address patients' concerns and expectations, communication skills, humanistic qualities, and perceived technical competence.8 Although communication workshops9-10 may improve some of these physician-specific factors, such changes often take time, and it is uncertain if physicians' behavioral changes could be sustained or would result in improved patient outcomes.
One element of patient satisfaction that the physician can immediately and/or directly influence is whether patients' visit-specific concerns and expectations are addressed at the clinic visit. Several studies suggest that patients often have a specific agenda when they visit their physicians.2, 11-12 This agenda includes the particular problems that the patients would like the physician to address; their concerns about the cause, seriousness, or prognosis of those problems; and their desires for specific actions (ie, test ordering, prescription of medication, referral to a specialist, providing a work excuse).13-14 Although this agenda may be obvious among patients with specific complaints, even those seen for routine health maintenance or follow-up visits may have concerns or expectations that are unrelated to their chronic conditions.15
The patient's primary concerns frequently differ from the physician's agenda16-18 and often go undetected,19-20 resulting in a lower level of satisfaction with care.8, 14 However, confusion remains regarding the exact nature of the relationship between expectation fulfillment and patient satisfaction. For example, does the extent to which physicians address patients' expectations result in greater satisfaction with care? Furthermore, what are the effects of expectation fulfillment on important clinical outcomes, such as compliance, clinical parameters, health-related quality of life, or health care utilization? What can health systems do to facilitate patient-physician communication about visit-specific expectations and concerns? Finally, what are the gaps in our knowledge regarding unmet expectations?
Given this background, we reviewed the literature on patients' visit-specific expectations, focusing on studies of adult patients seen in primary care settings. The major purpose of this review is to examine the relationship between fulfillment of visit-specific expectations and patient-centered outcomes, including satisfaction, compliance, and health-related quality of life.
PATIENTS AND METHODS
We performed a MEDLINE search to identify all potentially relevant articles published in the English language between 1966 and January 1, 1999. First we searched for all articles for which the title included any one of the following words (in any form): expect, desire, concern, or request. Next we searched for all articles using a combination of the following MeSH terms: physician-patient relations, consumer satisfaction, primary health care, or ambulatory care. We combined the results of these 2 MEDLINE searches and excluded citations that contained pregnancy, surgical procedures, dental, child or pediatric, nursing, letters, editorials, or news as indexing terms. This search strategy retrieved 182 potentially relevant citations. We also manually examined the reference lists of review articles and retrieved an additional 4 potentially relevant articles.
Studies were included if they (1) were conducted in the primary care setting; (2) systematically recruited a sample of adult outpatients; (3) measured patients' visit-specific expectations either before or after a particular clinic visit; and (4) measured outcomes from the patients' perspectives (ie, expectation fulfillment, satisfaction, compliance, or health-related quality of life).
Two physicians independently reviewed each included study in detail to abstract information on (1) study design, number of participating patients, and clinical setting; (2) types of expectations (ie, problem-specific or general), timing (ie, previsit or postvisit), and method (ie, face-to-face interview or questionnaire) of measurement of those expectations; and (3) study outcomes.
RESULTS
STUDY CHARACTERISTICS
Twenty-three studies met inclusion criteria for this review (Table 1). A total of 5971 patients were studied in a variety of sites, including university, Veterans Affairs, community, and military clinics. Two studies13, 21 primarily enrolled managed-care patients. Thirteen studies focused on patients with scheduled appointments at continuity clinics, 7 focused on patients at walk-in clinics, and 3 did not specify the appointment type (but were assumed to be scheduled visits). Six were randomized controlled trials9, 22-26 1 was a pre-post trial,27 4 were cohort studies,13-14,28-29 and 12 were cross-sectional studies.8, 15, 21, 30-38
|
|
|
|
Table 1. Characteristics of Included Studies*
|
|
|
In all studies, patients' expectations and outcomes were measured within the context of single visits. Four studies elicited patients' expectations through interviews, whereas the remainder used questionnaires containing 2 to 42 items (Table 2). Most (17 of 23) measured both previsit and postvisit expectations, but a few measured only postvisit13, 25, 29, 34-35 or previsit expectations.9 Five studies8, 14, 32-33,38 assessed concordance between patients' expectations and physicians' perceptions of these expectations. Three studies14, 32-33 found that physicians often did not accurately recognize the patients' expectations: whereas patients frequently desired information, physicians believed that the patients expected specific actions such as test ordering, medication prescription, or referrals.
|
|
|
|
Table 2. Relationship Between Primary Care Patients' Visit-Specific Expectations and Outcomes*
|
|
|
All 23 studies provided information on the patients, but only 14 described the physicians who saw those patients. Of these studies, 7 provided information on the physicians' level of experience or training,9, 14-15,23, 26-28 and 6 9, 15, 23, 33-34,37 mentioned the physicians' demographic characteristics. One study9 described the physicians' attitudes toward patient care and job satisfaction.
Several studies focused on the concerns of patients with specific complaints, including upper respiratory tract symptoms,25, 28, 32, 34, 36 diabetes mellitus,29 or physical symptoms.14, 21-22,27, 30-31 In these studies, patients' expectations regarding specific physician actions, such as medication prescription or diagnostic testing, were assessed using survey instruments that contained fewer questions (6-14 items) than those that elicited general expectations from patients. In many studies, including those focusing on general as well as problem-specific concerns, information and personal reassurance were often sufficient to meet patients' expectations for the visit.21, 25, 30-33,36, 39
The trials differed with respect to who was randomized (ie, physicians or patients) and the degree to which physicians received information on patients' previsit expectations. Two trials9, 23 randomized physicians. In one,9 intervention physicians were provided with information on the patients' previsit requests. In the other, the previsit concerns of only the last 10 patients (one quarter of all study patients) were provided to the intervention physicians.23 For the remaining patients (75% of all patients), only postvisit expectations were assessed, and physicians did not have access to this information. Similarly, trials that randomized patients22, 24-26 differed regarding the degree to which physicians were exposed to their patients' expectations. For example, one study provided physicians with the previsit expectations of a randomly selected sample of their patients.26 Another randomized patients to different methods of expectation elicitation24 but did not provide physicians with this information. Two studies23, 27 found that physicians who had access to the patients' previsit concerns were more satisfied with the encounter.
RELATIONSHIP OF EXPECTATIONS WITH OUTCOMES
In all but 2 studies,9, 23 the patient was the unit of analysis. Two studies24, 27 focused on the effect of physician characteristics. Most examined whether patients' previsit expectations were met by the physicians during the visit. An intervention that provided physicians with patients' previsit expectations reduced unmet expectations by 50%.27 As presented in Table 2, most studies (19 of 23) assessed satisfaction as a primary outcome. A positive association between meeting patient expectations and a higher level of satisfaction was demonstrated in 11 studies, inconclusive in 3, and not established in 5. In one study,22 the lack of relationship was actually a positive result: patients with low back pain and expectations for lumbar spine radiographs were randomized to immediate testing vs an educational program (about diagnosis and management of low back pain), and no differences were found in satisfaction between groups.
A few studies measured other patient outcomes, such as symptom or disease improvement, health status, compliance, utilization, and physician satisfaction. Symptom improvement25, 28 or disease control29 was associated with expectation fulfillment in 3 studies, with no relationship shown in 2 others.22, 30 One study29 indicated a direct association between health status and expectation fulfillment, whereas 4 14, 22-23,27 showed no relationship. One study suggested that information provided by the physician may enhance the effect of medication: patients randomized to information along with tonsillitis treatment had more symptom improvement and greater satisfaction than those who received a prescription alone.25 The data regarding the expectation fulfillment–compliance relationship are conflicting: one study29 found improved compliance, whereas another9 showed no association. With respect to utilization, 2 studies found that patients with unmet expectations were more likely to return for similar symptoms34 or to buy prescriptions on their own.35 An intervention that provided physicians with patients' expectations not only resulted in the discussion of more diagnoses at patients' visits but also increased visit length.23 However, 1 study indicated that meeting patients' expectations22 resulted in lower costs and fewer return visits or testing. Finally, 2 studies found that providing information on patients' expectations to physicians improved physician satisfaction with the encounter.23, 27
COMMENT
The general term expectations is often used to indicate what patients hope will happen, whether or not they explicitly verbalize this expectation as a request.1, 11, 39 Although physicians may believe that they have to do something (ie, order a test, prescribe a medicine) to satisfy patients' expectations for the visit, the literature suggests that patients frequently desire information.12, 19-20 Given that an estimated 15% to 25% of primary care patients have unmet expectations,13, 27 it is apparent that identifying the patient's agenda is an important step to improving patient satisfaction and possibly other health outcomes.
Several investigations have evaluated the effect of patients' previsit expectations on outcomes using a variety of techniques and study designs. The primary conclusions that emerge from our review of this literature are summarized in Table 3. All of the studies measured expectations and outcomes in relation to single patient visits. Although there appears to be a link between the degree of expectation fulfillment and satisfaction with care, the evidence is inconclusive. Of the 19 studies that assessed patient satisfaction, 11 showed a positive association between expectation fulfillment and greater satisfaction. Of the 6 trials that actually included an intervention to elicit patients' previsit expectations, 3 had a positive effect on satisfaction, whereas 3 were negative. There are several possible explanations for these mixed results.
|
|
|
|
Table 3. Summary of Studies Examining Visit-Specific Expectations in Primary Care
|
|
|
First, several studies administered previsit concerns checklists containing numerous items to patients. Such extensive checklists may not only create an overwhelming menu of issues for the physician to address during the visit but also raise the patient's expectations of what the physician is going to do. Thus, if these expectations are not met, lower satisfaction with the actual encounter may result. Second, in attempting to examine the prevalence8, 13, 15, 21, 28-34,36-37 of unmet expectations, many investigators elicited the patients' previsit expectations but did not provide this information directly to physicians, perhaps with the belief that the patients themselves raised these issues during the visit. However, that strategy strongly depends on patient initiative and ability to interject control over the visit agenda. Third, some studies provided communications workshops to physicians to teach them how to elicit patients' expectations themselves or use previsit questionnaires.9, 23 Although these studies indicate that physicians who receive such training are more likely to elicit the patients' concerns, it is uncertain if such behavioral changes can be sustained. Fourth, a few studies evaluated9, 23, 26-27 the effect of providing physicians with the patients' expectations. In some of them,26-27 the previsit expectations were elicited from all patients (control and intervention), a practice that might have primed the control patients to bring their agenda to the physician's attention. Thus, the control patients were not a "pure" control group, potentially decreasing the ability to make true comparisons to usual care. Finally, no study evaluated the incremental effect of routine expectation elicitation in a continuity setting during a series of primary care visits on improving patient outcomes.
We must acknowledge several limitations of our review. First, because we restricted our review to studies performed in primary care settings, our findings may not be applicable to patients seen in other environments, such as surgical clinics, inpatient settings, and specialty clinics. Patients in those environments may have different expectations from those in primary care settings. Similarly, a large number of the studies we reviewed were performed in academic settings, which may represent a potential source of bias. Patients who attend academic centers often do not represent those who visit community practices. Second, we intentionally chose an inclusive approach in surveying the literature, thereby involving a variety of study designs and measures. As a result, the heterogeneity of the included studies may explain the differing conclusions. Third, this same heterogeneity of published studies (too few sharing similar designs and measures) precluded a quantitative pooling of study results and formal meta-analysis.
As managed-care penetration increases, addressing patients' concerns can be particularly difficult given the substantial time constraints on physicians to address an often full visit agenda (such as chronic health problems and preventive care) and the external pressures to see more patients in less time. Some physicians may adopt a "don't ask" approach because of concerns about opening a Pandora's box of potentially difficult issues that would negatively affect their ability to see patients efficiently. Previous studies highlight potential opportunities to evaluate innovative interventions to enhance patient-physician communication regarding expectations and to advance this field of research. Intensive patient-focused (ie, patient activation) interventions are not feasible in the current health care environment and are unlikely to be welcomed by physicians or cost-conscious health systems. Furthermore, having patients complete extensive previsit concerns checklists is unrealistic in a busy clinical setting and may not provide clinically useful information to physicians. Future studies should focus on efficient methods to elicit patients' previsit expectations, ask patients to prioritize these concerns, and provide these data to physicians in a manner that is pragmatic in a busy clinical setting. Interventions should rigorously evaluate the effect of this intervention on patient-centered outcomes, clinical outcomes, and cost by providing a true comparison with usual care. Finally, it will be important to conduct a longitudinal study in a continuity setting to determine if repeated elicitation of expectations affects satisfaction with care and other important patient-centered outcomes.
AUTHOR INFORMATION
Accepted for publication July 28, 2000.
This work was supported in part by the Health Services Research Career Development Program, Department of Veterans Affairs, Washington, DC (Drs Rao and Weinberger), and the Picker-Commonwealth Scholars Program in Patient-Centered Care, The Commonwealth Fund, New York, NY (Dr Rao).
Corresponding author: Jaya K. Rao, MD, MHS, Health Care and Aging Studies Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop K-45, Atlanta, GA 30341-3724.
From the Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC (Dr Rao); Center for Health Services Research, Roudebush VAMC (Dr Weinberger); Division of General Internal Medicine, Indiana University School of Medicine (Dr Kroenke); and Regenstrief Institute for Health Care (Drs Weinberger and Kroenke), Indianapolis, Ind.
REFERENCES
| |
1. Kroenke K. Patient expectations for care: how hidden is the agenda? Mayo Clin Proc. 1998;73:191-193.
ISI
| PUBMED
2. Laine C, Davidoff F. Patient-centered medicine: a professional evolution. JAMA. 1996;275:152-156.
FREE FULL TEXT
3. Carr AJ, Donovan JL. Why doctors and patients disagree. Br J Rheumatol. 1998;37:1-6.
FREE FULL TEXT
4. Davies AR, Ware JE Jr. Involving consumers in quality care assessment. Health Aff (Millwood). 1988;7:33-48.
FULL TEXT
| PUBMED
5. Marquis MS, Davies AR, Ware JE Jr. Patient satisfaction and change in medical care provider: a longitudinal study. Med Care. 1983;21:821-829.
FULL TEXT
|
ISI
| PUBMED
6. Patrick DL, Martin DP, Madden CW, Diehr P, Cheadle A, Skillman SM. Dissatisfaction and disenrollment in a subsidized managed care program. Med Care Res Rev. 1997;54:61-79.
FREE FULL TEXT
7. Ware JE Jr, Davies AR. Behavioral consequences of consumer dissatisfaction with medical care. Eval Program Plann. 1983;6:291-297.
FULL TEXT
| PUBMED
8. Kravitz RL, Cope DW, Bhrany V, Leake B. Internal medicine patients' expectations for care during office visits. J Gen Intern Med. 1994;9:75-81.
ISI
| PUBMED
9. Joos SK, Hickam DH, Gordon GH, Baker LH. Effects of a physician communication intervention on patient care outcomes. J Gen Intern Med. 1996;11:147-155.
ISI
| PUBMED
10. Levinson W, Roter D. The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med. 1993;8:318-324.
ISI
| PUBMED
11. Kravitz RL. Patients' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev. 1996;53:3-27.
12. Price JH, Desmond SM, Losh DP. Patients' expectations of the family physician in health promotion. Am J Prev Med. 1991;7:33-39.
ISI
| PUBMED
13. Kravitz RL, Callahan EJ, Paterniti D, Antonius D, Dunham M, Lewis CE. Prevalence and sources of patients' unmet expectations for care. Ann Intern Med. 1996;125:730-737.
FREE FULL TEXT
14. Marple RL, Kroenke K, Lucey CR, Wilder J, Lucas CA. Concerns and expectations in patients presenting with physical complaints: frequency, physician perceptions and actions, and 2-week outcome. Arch Intern Med. 1997;157:1482-1488.
FREE FULL TEXT
15. Joos SK, Hickam DH, Borders LM. Patients' desires and satisfaction in general medicine clinics. Public Health Rep. 1993;108:751-759.
ISI
| PUBMED
16. Freiden RB, Goldman L, Cecil RR. Patient-physician concordance in problem identification in the primary care setting. Ann Intern Med. 1980;93:490-493.
17. Starfield B, Steinwachs D, Morris I, Bause G, Siebert S, Westin C. Patient-doctor agreement about problems needing follow-up. JAMA. 1979;242:344-346.
FREE FULL TEXT
18. Starfield B, Wray C, Hess K, Gross R, Birk PS, D'Lugoff BC. The influence of patient-practitioner agreement on outcome of care. Am J Public Health. 1981;71:127-132.
FREE FULL TEXT
19. Sanchez-Menegay C, Stalder H. Do physicians take into account patient expectations? J Gen Intern Med. 1994;9:404-406.
ISI
| PUBMED
20. Zemencuk JK, Feightner JW, Hayward RA, Skarupski KA, Katz SJ. Patients' desires and expectations for medical care in primary care clinics. J Gen Intern Med. 1998;13:273-276.
FULL TEXT
|
ISI
| PUBMED
21. Brody DS, Miller SM, Lerman CE, Smith DG, Lazaro CG, Blum MJ. The relationship between patients' satisfaction with their physicians and perceptions about interventions they desired and received. Med Care. 1989;27:1027-1035.
FULL TEXT
|
ISI
| PUBMED
22. Deyo RA, Diehl AK, Rosenthal M. Reducing roentgenography use: can patient expectations be altered? Arch Intern Med. 1987;147:141-145.
FREE FULL TEXT
23. Hornberger J, Thom D, MaCurdy T. Effects of a self-administered previsit questionnaire to enhance awareness of patients' concerns in primary care. J Gen Intern Med. 1997;12:597-606.
FULL TEXT
|
ISI
| PUBMED
24. Kravitz RL, Callahan EJ, Azari R, Antonius D, Lewis CE. Assessing patients' expectations in ambulatory medical practice: does the measurement approach make a difference? J Gen Intern Med. 1997;12:67-72.
FULL TEXT
|
ISI
| PUBMED
25. Olsson B, Olsson B, Tibblin G. Effect of patients' expectations on recovery from acute tonsillitis. Fam Pract. 1989;6:188-192.
FREE FULL TEXT
26. Uhlmann RF, Carter WB, Inui TS. Fulfillment of patient requests in a general medicine clinic. Am J Public Health. 1984;74:257-258.
FREE FULL TEXT
27. Jackson J, Kroenke K, Chamberlin J. Effects of physician awareness of symptom-related expectations and mental disorders: a controlled trial. Arch Fam Med. 1999;8:135-142.
FREE FULL TEXT
28. Brody DS, Miller SM. Illness concerns and recovery from a URI. Med Care. 1986;24:742-748.
FULL TEXT
|
ISI
| PUBMED
29. Uhlmann RF, Inui TS, Pecoraro RE, Carter WB. Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes. J Gen Intern Med. 1988;3:458-463.
ISI
| PUBMED
30. Deyo RA, Diehl AK. Patient satisfaction with medical care for low-back pain. Spine. 1986;11:28-30.
FULL TEXT
|
ISI
| PUBMED
31. Froehlich GW, Welch HG. Meeting walk-in patients' expectations for testing: effects on satisfaction. J Gen Intern Med. 1996;11:470-474.
ISI
| PUBMED
32. Hamm RM, Hicks RJ, Bemben DA. Antibiotics and respiratory infections: are patients more satisfied when expectations are met? J Fam Pract. 1996;43:56-62.
ISI
| PUBMED
33. Himmel W, Lippert-Urbanke E, Kochen MM. Are patients more satisfied when they receive a prescription? the effect of patient expectations in general practice. Scand J Prim Health Care. 1997;15:118-122.
ISI
| PUBMED
34. Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997;315:1211-1214.
FREE FULL TEXT
35. Rapoport J. Patients' expectations and intention to self-medicate. J R Coll Gen Pract. 1979;29:468-472.
PUBMED
36. Sanchez-Menegay C, Hudes ES, Cummings SR. Patient expectations and satisfaction with medical care for upper respiratory infections. J Gen Intern Med. 1992;7:432-434.
ISI
| PUBMED
37. Williams S, Weinman J, Dale J, Newman S. Patients' expectations: what do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Fam Pract. 1995;12:193-201.
FREE FULL TEXT
38. Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24:351-357.
39. Uhlmann RF, Inui TS, Carter WB. Patient requests and expectations: definitions and clinical applications. Med Care. 1984;22:681-685.
FULL TEXT
|
ISI
| PUBMED
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Psychometric evaluation of an instrument to assess patient-reported 'psychosocial care by physicians': a structural equation modeling approach
Ommen et al.
Int J Qual Health Care 2009;21:190-197.
ABSTRACT
| FULL TEXT
Patient Satisfaction of Young Adults in Rural Clinics: Policy Implications for Nurse Practitioner Practice
Lemley and Marks
Policy Politics Nursing Practice 2009;10:143-152.
ABSTRACT
Unburdening the Difficult Clinical Encounter
Kroenke
Arch Intern Med 2009;169:333-334.
FULL TEXT
Patient expectations are not always the same
Delgado et al.
J. Epidemiol. Community Health 2008;62:427-434.
ABSTRACT
| FULL TEXT
Blood tests in tired elite athletes: expectations of athletes, coaches and sport science/sports medicine staff * Commentary
Fallon and Gerrard
Br. J. Sports. Med. 2007;41:41-44.
ABSTRACT
| FULL TEXT
Patient-Physician Fit: An Idea Whose Time Has Come
Krupat
Med Decis Making 2006;26:110-111.
Influence of Accompanied Encounters on Patient-Centeredness with Older Patients
Shields et al.
J Am Board Fam Med 2005;18:344-354.
ABSTRACT
| FULL TEXT
Expectations, Emotions, and Medical Decision Making: A Case Study on the Use of Amniocentesis
Browner and Preloran
Transcultural Psychiatry 2004;41:427-444.
ABSTRACT
Why We Don't Come: Patient Perceptions on No-Shows
Lacy et al.
Ann Fam Med 2004;2:541-545.
ABSTRACT
| FULL TEXT
Improving Health Care Experiences of Persons Who Are Blind or Have Low Vision: Suggestions From Focus Groups
O'Day et al.
American Journal of Medical Quality 2004;19:193-200.
ABSTRACT
What Complementary and Alternative Medicine Practitioners Say About Health and Health Care
Barrett et al.
Ann Fam Med 2004;2:253-259.
ABSTRACT
| FULL TEXT
Patient Expectations Regarding Eye Care: Focus Group Results
Dawn et al.
Arch Ophthalmol 2003;121:762-768.
ABSTRACT
| FULL TEXT
Paved With Good Intentions: Do Public Health and Human Service Providers Contribute to Racial/Ethnic Disparities in Health?
van Ryn and Fu
AJPH 2003;93:248-255.
ABSTRACT
| FULL TEXT
The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke et al.
Psychosom. Med. 2002;64:258-266.
ABSTRACT
| FULL TEXT
|
