Association of clinician denial of patient requests with patient satisfaction

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Abstract

IMPORTANCE Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. OBJECTIVE To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center. MAIN OUTCOMES AND MEASURES We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach a = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)—referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test—compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions. RESULTS The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4%) were female. Among 1319 visits, 897 (68.0%) included at least 1 request; 1441 (85.2%) were fulfilled. Requests by category were referral, 294 (21.1%); pain medication, 271 (20.5%); antibiotic, 107 (8.1%); other new medication, 271 (20.5%); laboratory test, 448 (34.0%); radiology test, 153 (11.6%); and other tests, 147 (11.1%). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, -19.75 [95% CI, -30.75 to -8.74], -10.72 [95% CI, -19.66 to -1.78], -20.36 [95% CI, -29.54 to -11.18], and -9.19 [95% CI, -17.50 to -0.87]), respectively. CONCLUSIONS AND RELEVANCE Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.

Original languageEnglish (US)
Pages (from-to)85-91
Number of pages7
JournalJAMA Internal Medicine
Volume178
Issue number1
DOIs
StatePublished - Jan 1 2018

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Patient Satisfaction
Referral and Consultation
Radiology
Pain
Anti-Bacterial Agents
Family Physicians
Health
Denial (Psychology)
Health Personnel
Health Status
Observational Studies
Personality
Outpatients
Cross-Sectional Studies
Delivery of Health Care
Physicians
Weights and Measures

ASJC Scopus subject areas

  • Internal Medicine

Cite this

@article{0e9cd45b54ea43f1bab3561bfa958752,
title = "Association of clinician denial of patient requests with patient satisfaction",
abstract = "IMPORTANCE Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. OBJECTIVE To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center. MAIN OUTCOMES AND MEASURES We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach a = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)—referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test—compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions. RESULTS The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4{\%}) were female. Among 1319 visits, 897 (68.0{\%}) included at least 1 request; 1441 (85.2{\%}) were fulfilled. Requests by category were referral, 294 (21.1{\%}); pain medication, 271 (20.5{\%}); antibiotic, 107 (8.1{\%}); other new medication, 271 (20.5{\%}); laboratory test, 448 (34.0{\%}); radiology test, 153 (11.6{\%}); and other tests, 147 (11.1{\%}). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, -19.75 [95{\%} CI, -30.75 to -8.74], -10.72 [95{\%} CI, -19.66 to -1.78], -20.36 [95{\%} CI, -29.54 to -11.18], and -9.19 [95{\%} CI, -17.50 to -0.87]), respectively. CONCLUSIONS AND RELEVANCE Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.",
author = "Jerant, {Anthony F} and Fenton, {Joshua J} and Kravitz, {Richard L} and Tancredi, {Daniel J} and Elizabeth Magnan and Bertakis, {Klea D} and Peter Franks",
year = "2018",
month = "1",
day = "1",
doi = "10.1001/jamainternmed.2017.6611",
language = "English (US)",
volume = "178",
pages = "85--91",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "1",

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TY - JOUR

T1 - Association of clinician denial of patient requests with patient satisfaction

AU - Jerant, Anthony F

AU - Fenton, Joshua J

AU - Kravitz, Richard L

AU - Tancredi, Daniel J

AU - Magnan, Elizabeth

AU - Bertakis, Klea D

AU - Franks, Peter

PY - 2018/1/1

Y1 - 2018/1/1

N2 - IMPORTANCE Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. OBJECTIVE To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center. MAIN OUTCOMES AND MEASURES We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach a = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)—referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test—compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions. RESULTS The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4%) were female. Among 1319 visits, 897 (68.0%) included at least 1 request; 1441 (85.2%) were fulfilled. Requests by category were referral, 294 (21.1%); pain medication, 271 (20.5%); antibiotic, 107 (8.1%); other new medication, 271 (20.5%); laboratory test, 448 (34.0%); radiology test, 153 (11.6%); and other tests, 147 (11.1%). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, -19.75 [95% CI, -30.75 to -8.74], -10.72 [95% CI, -19.66 to -1.78], -20.36 [95% CI, -29.54 to -11.18], and -9.19 [95% CI, -17.50 to -0.87]), respectively. CONCLUSIONS AND RELEVANCE Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.

AB - IMPORTANCE Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. OBJECTIVE To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center. MAIN OUTCOMES AND MEASURES We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach a = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)—referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test—compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions. RESULTS The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4%) were female. Among 1319 visits, 897 (68.0%) included at least 1 request; 1441 (85.2%) were fulfilled. Requests by category were referral, 294 (21.1%); pain medication, 271 (20.5%); antibiotic, 107 (8.1%); other new medication, 271 (20.5%); laboratory test, 448 (34.0%); radiology test, 153 (11.6%); and other tests, 147 (11.1%). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, -19.75 [95% CI, -30.75 to -8.74], -10.72 [95% CI, -19.66 to -1.78], -20.36 [95% CI, -29.54 to -11.18], and -9.19 [95% CI, -17.50 to -0.87]), respectively. CONCLUSIONS AND RELEVANCE Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.

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