- Clinicians need better guidance about patient-provider communication to help facilitate stronger shared decision-making, patient goal-setting, and clinician advice-giving, according to new research published in the Journal of the American Board of Family Medicine.
According to the research team, clinicians specifically need better guidance about discussing health risk assessments (HRAs) during annual wellness visits (AWVs). HRAs are tests of certain health determinants that, per the Affordable Care Act, are tied to Medicare payments.
“Although payment for Medicare AWVs is a step in the right direction, much work needs to be done to identify and test effective approaches to implementing AWVs in community settings,” the researchers said.
Healthcare professionals typically have little knowledge about patient participation in HRA conversations. Clinicians need better guidance on how to facilitate better shared decision-making, patient empowerment, and goal-setting. Additionally, clinicians need more guidance on issuing health advice and documenting that advice in the patient’s health record.
The researchers conducted conversation analysis on 40 annual physicals over a three-month period to help design their conversation guide.
Study administrators then educated clinicians on better conversation techniques to promote motivational interviewing, collaborative goal-setting, and HRA report understanding. Clinicians also learned about coding to optimize AWV reimbursement.
Research assistants conducted five-minute orientations with patients prior to their AWVs to help them consider their personal healthcare goals and improve their communication techniques with their clinicians.
The intervention improved patient-provider conversations, the researchers reported. Guidance reduced clinician talk time by nine percent and increased patient talk time by seven percent. This shows that patients drove HRA conversations, a sign of better patient engagement.
The intervention also improved clinician advice-giving and patient goal-setting, with patient goal-setting increasing by 639 percent.
According to the researchers, study participants were receptive to the conversation guidance.
“Patients felt more informed, empowered, and motivated by the HRA-enhanced wellness visit,” the research team wrote. “Clinicians found that the process helped them construct a more effective visit agenda and it facilitated the convergence of patient goals with evidence-based recommendations.”
The results suggest that integrating HRAs into AWVs is not effective unless patients and providers receive proper guidance on how to utilize HRA information. Furthermore, the study highlighted areas in which the conversation intervention may be strengthened.
For example, the study shows that guidance needs to strongly reinforce the importance of patient goal-setting, which was still slightly lacking following the study’s intervention.
“Despite a considerable improvement of change talk and favorable shifts in health conversation dynamics, our intervention did not improve goalsetting conversations,” the researchers said.
“Adjustments may include additional emphasis on patient empowerment for goal setting through patient and clinician education and direct feedback to clinicians regarding selected visits observed by a professional trained in MI and goal setting.”
The researchers also pointed out additional challenges that will require further investigation. For example, integrating HRAs into AWVs may be difficult due to provider time constraints.
Conversely, providers may have difficulty introducing HRAs using remote digital tools because of privacy concerns or patient access to digital tools.
Despite some necessary improvements, these findings present a path forward for improving patient-provider communication, patient goal-setting, and shared decision-making.
“Our study suggests that HRAs introduced without proper framing, education, and additional resources may not allow patients and clinicians to optimally leverage AWVs for health planning and improvement,” the research team concluded.
“Although more research is needed to find an optimal intensity and combination of clinician- and patient-facing interventions, our study suggests that even limited investments into improving interactions during AWVs may facilitate effective health improvement in primary care settings.”