Impact of a simple intervention to increase primary care provider recognition of patient referral concerns.

OBJECTIVE: To determine whether a brief previsit questionnaire about referral concerns can improve primary care provider (PCP) recognition of patient concerns and satisfaction with care.
DESIGN: Sequential prospective study in the internal medicine clinic of an academic medical center providing primary care to patients enrolled in a gatekeeper-model managed care plan. PARTICIPANTS AND METHODS: Twelve faculty internists serving as PCPs for 1495 consecutive patient visits. Patients were given a previsit questionnaire asking about referral need and rationale and a postvisit questionnaire asking about discussion of referral concern and visit satisfaction. Providers were given a postvisit questionnaire asking whether a referral was discussed and made and about visit satisfaction. In the control phase, patient previsit questionnaires remained confidential, whereas in the intervention phase PCPs were shown the previsit questionnaires at the time of encounter.
RESULTS: The intervention significantly increased PCP referral recognition from 61% to 81% (P < .001) and was associated with increased visit satisfaction (P = .05). Satisfaction of PCPs with the referral discussion, overall rate of referral, and visit duration were not affected by the intervention.
CONCLUSIONS: Using a brief previsit questionnaire about patient referral concerns increases PCP recognition of such concerns. The intervention does not adversely affect PCP satisfaction with the referral discussion or the overall referral rate and may enhance patient visit satisfaction.