The Effect of Families on the Process of Outpatient Visits in Family Practice

Journal of Family Practice, Oct, 2001 by Deborah S. Main, Sherry Holcomb, Perry Dickinson, Benjamin F. Cratree

KEY POINTS FOR CLINICIANS

* Family physicians have many opportunities to
talk with patients and their families about family
history and family context.

* Physician knowledge of family context is an
important factor in medical decision making and
can be classified as 1 of 6 types.

* Long-lasting relationships between physicians
and their patients and families should be
encouraged in current and future systems of primary
care.

* OBJECTIVE Our goal was to describe how physician knowledge of and interactions with patients' families affect the processes of patient care in family practices.

* STUDY DESIGN Using a multimethod comparative case study design, detailed field notes were recorded after direct observation of patient encounters and the office environment as part of The Prevention and Competing Demands in Primary Care Study. We identified domains of outpatient visits in which patients were accompanied by a family member or in which family-oriented content was discussed.

* POPULATION Outpatient encounters with 1637 patients presenting in 18 family practices in the Midwest were analyzed using an editing style.

* OUTCOMES We developed a typology for ways in which family context affects outpatient visits.

* RESULTS Patients were accompanied by a family member during 35% of all outpatient visits, with the vast majority of these visits involving children. Family history or a family member's problems were discussed during 35% of visits during which no family member was present. An analysis of these "family-oriented" visits resulted in a typology of 6 ways that family context informs and affects the outpatient visit: (1) using family social context to illuminate patient disease, illness, and health; (2) using family to discover the source of an illness; (3) discussing and managing the health and illness of family members; (4) family concern for patient's health; (5) using the family as a care resource and care collaborator; and, (6) giving family members unscheduled care.

* CONCLUSIONS Family context is an important feature of family practice that influences the processes of patient care. Since family-oriented care is an essential feature of family practice, outcomes of this largely hidden part of care deserve further study.

* KEYWORDS Family practice; patient-centered care; physician-patient relations; qualitative methods [non-MESH]. (J Fam Pract 2001; 50:888)

Submitted, revised, August 13, 2001. From the Department of Family Medicine, University of Colorado Health Sciences Center, Denver (D.S.M., S.H., P.D.); the Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School and the Cancer Institute of New Jersey, New Brunswick (B.F.C.); and the Center for Research in Family Practice and Primary Care (B.F.C.). Reprint requests should be addressed to Deborah S. Main, PhD, Department of Family Medicine, University of Colorado Health Sciences Center, 1180 Clermont St, Denver, CO 80020. E-mail: debbi.main@uchsc.edu.

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