Which Medicines Do Our Patients Want From Us?
METHODS: We surveyed 244 consecutive adult patients who presented to an urban private family medicine practice in Georgia.
RESULTS: Regardless of who paid for prescriptions (an HMO or the patient), most people in the survey would be satisfied with over-the-counter medications and reassurance (84% for upper-respiratory infection, 72% for muscle strain, 56% for diarrhea). Few differences were attributable to payment status (prepaid as opposed to fee-for-service). African Americans are less likely than whites to accept reassurance as an appropriate treatment.
CONCLUSIONS: Patients may be more willing to accept reassurance and over-the-counter medications than is commonly believed by physicians.
As health maintenance organizations (HMOs) and physicians increasingly become medical partners, the HMO formularies and prescribing recommendations will be more evident in physicians’ practices. Upper-respiratory infections and low back pain are so common and often so difficult to treat that they are prime targets for HMO intervention.
A recent study showed that HMO physicians, perform less diagnostic testing, but may prescribe more antibiotics for viral illnesses than other physicians.1 Often the physician believes the patient expects antibiotics when that is not the case.2-5 In turn, patients may feel they need treatment for self-limited conditions because they have received them in the past.6
Physicians may believe that patients will be dissatisfied when expectations are not met. Dissatisfied patients are less likely to comply with physicians’ treatment recommendations.7 Patients may continue to call or visit the physician until expectations are met.8 Sometimes physicians think that patients will go elsewhere to get treatment. We asked patients for their opinions on the need for prescriptive medications and compared prepaid and fee-for-service (FFS) patients.
Methods
A total of 244 consecutive patients or parents of patients in an urban family medicine clinic completed survey forms in October 1997. This was an undifferentiated patient population seeking care for any reason. No attempt was made to screen for the reason for the visit. Parents completed the questionnaire for any child in the consecutive grouping. The questionnaire addressed perceptions of appropriateness of the frequency of medication prescription in general, reassurance or prescriptions as treatments related to 3 specific problems (virus, muscle straining, diarrhea), and preferred timing of treatment modification. No one refused to complete the questionnaire.
Men made up 37% of the sample (n=91) and women 63% (n=153). Patients were mostly white (n=191, 78%), with a substantial African American minority group (n=50, 21%), and 1% were of other ethnicities. Eighteen percent of the sample were single (n=44); 66%, married (n=160); 7%, widowed (n=16); and 9%, divorced or separated (n=23). Most of the patients were aged 30 to 59 years, with 17% 60 years or older and 20% 29 years or younger.
Sixty-seven percent of the sample were HMO members and 30% were fee-for-service patients. Most of the HMO members were charged a flat fee for medications (63%). White patients were more likely to be enrolled in an HMO than African Americans (72% vs 59%, respectively; c2= 2.937; P <087).
Analyses were largely descriptive with chi-squares conducted for group comparisons of categorical variables. Respondents were excluded from analyses if any item was missing. We conducted 2-way analysis of variance on continuous treatment change questions to compare race and HMO status.
Results
Medication Questions
Most respondents indicated that they did not believe physicians prescribed too many medications (75%). Eighty-four percent of the patients would want an expensive medicine if the physician recommended it. In a comparison of patients who had a set fee for medicine with those who did not, 88% with the set fee said they would want the more expensive medications as opposed to 77% in the group without a set fee (c2= 3.39, P <.066). African Americans were less likely to want the more costly medicine than were whites (79.6% vs 92%, respectively; c2= 6.471; P <.011).
Reassurance and Prescription Questions
We asked several questions regarding personal preferences about receiving prescriptions, reassurance, or antibiotics for virus, muscle strains, and diarrhea. Reassurance and over-the-counter treatments were seen as sufficient care for viruses (84%), muscle strain (72%), and diarrhea (56%). In contrast, when asked if they would want an antibiotic or pain medication “just to be sure,” 43% said yes in the case of a virus, 37% for a muscle strain, and 92% for diarrhea.
For viruses, we found a significant difference in preferences (P <.001) by race, with white patients more likely to accept reassurance as sufficient care (76%) than African Americans (51%). African Americans were also less likely than whites to see reassurance as sufficient for muscle strain (P <001) and diarrhea (P <.06). Table 1 shows the percentages of patients accepting reassurance. When asked about prescriptions, “just to be sure,” race and HMO membership influenced the outcome, with more African Americans than whites likely to want an antibiotic for a virus (P <001) as were more FFS members than HMO members (P <.001). For a muscle strain, FFS members and African Americans were again more likely to want painkillers “just to be sure.” For diarrhea, FFS respondents were more likely than HMO respondents to want an antibiotic (P <.03), and there was a similar trend for African Americans to prefer the medication (P <.06). Table 2 shows the percentage of patients wanting medication “just to be sure.”
