How does the presence of an accompanying person influence a patient-doctor interaction in family practice? Information on interviewing couples or families with problems is readily available in the social science and family medicine literature. While earlier research has documented the importance of patient-doctor communication on patient satisfaction, symptom resolution, reduction of concern, and physiologic outcomes, very little research has examined the influence of people who accompany patients on everyday visits to the doctor. The few studies that have been conducted focus on the elderly or children and cancer patients.

The elderly population has been studied primarily in the context of internal medicine consultations. Children’s visits often provide the “ticket of entry” for parents to attend to their own medical needs. Pantell et al found that physicians’ interactions with parents and with children were different and concluded that children were not active participants in their own medical care. Accompanying people have been found to assume various roles that can facilitate or impede encounters and support or detract from patient-doctor relationships.

No one study has examined the prevalence of visits to family physicians’ offices during which patients of all ages are accompanied by other people. Few studies have focused specifically on family practice settings and none, to our knowledge, have considered the Canadian context. Before embarking on a large intervention study examining interactions among physicians, patients, and accompanying people, we thought it important to establish the prevalence and the characteristics of the various dyads presenting in family practice. Therefore, this study aimed to determine the prevalence of office visits during which patients were accompanied by other people (eg, partner, child, relative, friend); the demographic characteristics and role(s) assumed by the main accompanying person and, from that, the nature of presenting dyads; and the influence of the main accompanying person on patient-doctor interactions. This study was approved by the Review Board for Health Sciences Research Involving Human Subjects at The University of Western Ontario. buy brand cialis

METHODS

Sample
A convenience sample of eight family physicians was recruited by the investigators. The physicians, equally drawn from urban and rural settings in and around London, Ont, represented both academic (three) and community-based (five) practices. The two female and six male physicians were all certificants of the College of Family Physicians of Canada. Initial recruitment conducted by telephone was followed by a letter of information and a consent form mailed to physicians’ offices. generic ampicillin

Procedures
Upon return of the consent form, a package with 100 survey questionnaires and an instruction sheet was mailed to each physician. Physicians were asked to complete the 12-question survey for each of 100 consecutive patients attending their offices for both regularly scheduled and emergency visits.

The survey sought information on patients’ demographic characteristics (age and sex); presenting problem (acute or chronic); whether or not a patient was accompanied by another person; how many people accompanied a patient; demographics of the main accompanying person (relationship to the patient, age, and sex); whether the accompanying person(s) had a booked appointment; physician’s perception of the most relevant role assumed by the main accompanying person (silent observer, patient advocate, interpreter, spokesperson, unbooked patient); how the physician would characterize the interaction of the main accompanying person with both the patient and the doctor (supportive, obstructive, caring, respectful, angry, other); the physician’s perception of the overall influence of the main accompanying person on the patient-doctor interaction (positive, negative, neutral); and the length of time the physician had known the patient. canadian ampicillin

Survey content, wording, and format were reviewed by the physician partners of the Thames Valley Family Practice Research Unit’s Liaison Committee and were pilot tested also in two physicians’ offices. These physicians’ recommendations were incorporated into the survey, and the role descriptions and influence of accompanying people were deemed clear.

Analysis
A sample size for number of patient visits was calculated using a sample size table for descriptive studies involving a dichotomous variable. Given the findings of Knishkowy and colleagues, we expected that the proportion of patient visits involving an accompanying person would be approximately 35%. Taking a 95% confidence interval, a type II error rate of .10, and an expected proportion of between .30 and .40 patient visits involving accompanying persons, we needed a minimum of 346 documented patient visits to estimate the prevalence of accompanied patient visits.
The survey listed five categories of relationships for the presenting dyads. In the absence of data with which to estimate prevalence, we assumed a 20% prevalence for each category. To detect this within a confidence interval of .10, we required 246 dyads. Estimating the prevalence to be 35%, we then needed more than 400 encounters. Modest oversampling and rounding led us to seek eight physicians for 100 encounters each. Canadian Pharmacy prednisone

All analyses were performed using the Statistical Package for the Social Sciences (SPSS-PC). Preliminary data analysis involved simple descriptive summary statistics. Data were grouped into naturally occurring patient and accompanying person configurations, or dyads. X2 analyses were conducted to explore associations between dyads and patients’ ages, relationships with accompanying people, and other visit variables.