When patients have contextual issues that interfere with their healthcare, such as transportation issues or financial struggles, more than four in 10 doctors do not form a care plan with these challenges in mind, according to a study using 774 real patients who secretly audio recorded their visits with 139 resident physicians at two Chicago VA facilities.
What's more, in the 59 percent of cases in which physicians did create a contextualized care plan, there was a good outcome 71 percent of the time, noted the study, which is published April 16 in the Annals of Internal Medicine. When context was not factored into patients' care plans, bad outcomes occurred in 54 percent of cases.
"If the patient has, for example, a chronic condition like diabetes or hypertension that's going out of control we would say that that's also a contextual issue and probably a sign that something is going on in that patient's life that needs to be addressed," said lead author Dr. Saul Weiner, professor of medicine, pediatrics and medical education at UIC and staff physician at the Jesse Brown VA Medical Center, in an announcement.
While it may seem intuitive that physicians would address challenges patients divulge explaining why they miss appointments or fail to comply with instructions, Weiner said, his is "the first study to document an association between contextualizing patient care and patient care outcomes."
Among the 548 "red flags" identified from the recordings of patient encounters, 208 contextual factors were confirmed either when physicians probed or patients volunteered information, according to researchers.