- Patient-provider communication and collaboration can lead to better appointment agenda-setting, according to a recent study published in the Journal of the American Board of Family Medicine.
Appointment preparation has become an important topic in patient care, as providers face a litany of quality reporting requirements and increasingly complex patients with multiple conditions. Setting a schedule for an appointment and determining the topics to be covered is an essential part of making the most of an already short office visit.
“In this context of too much to do in too little time, the ability of patients and their physicians to work together to identify and align priorities for a visit may represent a critical, underdeveloped skill necessary for effective primary care,” the research team said. “Such effective collaboration is of particular importance for complex patients due to the many different questions and concerns these patients may have about their health care.”
But these pre-appointment preparations don’t always happen, and when they do, they aren’t always effective. Patients and providers who set appointment agendas have different priorities about one-third of the time, the researchers said, which can cause a rift in patient-provider communication.
“Time constraints require patients and physicians to implement proactive strategies early in the visit to better manage their limited time together,” the research team noted. “When this process was not well aligned, interactions during visits tend to suffer.”
The researchers sought to understand the challenges associated with appointment agenda-setting and patient-provider collaboration on the matter. Assessing such can help set best practices for both patients and providers working together to create set appointment discussion topics.
The researchers conducted qualitative interviews with 40 complex patients and 17 primary care providers. The team asked the participants about how they prepare for visits, how they set the agenda, and how they set discussion priorities.
The team identified factors that contributed to better appointment flow, such as when both the patient and provider are prepared for the visit, when patients bring up high-priority items at the start of the visit, when patients and providers work together to set the agenda at the start of the visit, and when other care team members participated in agenda-setting.
Conversely, several factors detracted from appointment flow, such as pressure from short appointment times, different expectations between patient and provider, patient hesitancy to raise uncomfortable questions, EHR documentation requirements, differences balancing current medical concerns and future risks, nonactionable items, different philosophies about treatments or lifestyle changes, and difficulty for patients in prioritizing their concerns.
In all, these findings led to three recommendations on the part of the researchers. First, strong patient education on how to prepare for a healthcare encounter can help them learn to prioritize their concerns and become more activated in their own care.
Second, provider training can help clinicians work with patients to develop agenda-setting skills.
Third, involving other care teams can help better direct appointment agenda-setting and streamline the appointment. Organizations that lean on the patient-centered medical home model will help spark better patient activation in appointment preparation, the researchers explained.
Overall, patients and providers both need better education about their respective unique insights into the care encounter. For example, nonactionable items stalled appointment agenda-setting. Patients often called attention to certain concerns that the provider could not control. When patients understand that dichotomy, they may identify more useful priorities.
Similarly, patients often prioritized immediate health concerns or symptoms, while providers prioritized downstream health impacts of a disease. Patients and providers need to understand their different points of view to better collaborate and communicate.
“Making significant changes to our current system is a major long-term endeavor,” the researchers concluded. “Our findings suggest initial efforts focused on patient and provider training related to visit preparation and agenda setting may help improve the complex process of primary care.”