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

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Original Research

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

J Fam Pract. 2001 October;50(10):888

References

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Limitations

Despite the uniqueness of the data and the grounded analysis approach, the findings must be interpreted within the context of the study limitations. Because these data were collected by field researchers who were unaware that family context would be a focus of the analysis, it is possible that there were other patient and physician behaviors related to family issues that were not recorded. The data were sufficiently rich, however, to easily assess the effect of family knowledge on physician and patient decision making. Any unrecorded behaviors might add to but should not substantially change our conclusions. Since the patient population studied was limited to a single Midwestern state, it is possible that other populations with a different ethnic and/or racial mix might behave differently. Future research of this type should attempt to include such populations.

Conclusions

Our study demonstrates that physician knowledge of family context gained from the care of multiple family members over time improves the quality of medical decision making and may account in part for the better outcomes that have been shown to result from continuous and comprehensive care.^15-18 The current health care environment, driven by managed care does not value or encourage the long-term relationships between physicians and family members that are necessary to develop the kind of family knowledge and connectedness shown by the physicians we studied. Further research in this area should focus on outcomes in patients whose physicians are informed by family context. Such data may help convince health policymakers and legislators of the importance of continuity of physician-family relationships in the delivery of high-quality primary health care.

Acknowledgments

This study was supported by a grant from the Agency for Healthcare Research and Quality (R01 HS08776) and a Family Practice Research Center grant from the American Academy of Family Physicians. We are grateful to the physicians, staff, and patients from the 18 practices without whose participation our study would not have been possible. We also wish to thank Drs Kurt C. Stange and John G. Scott who provided helpful comments on earlier drafts of this paper. Dr Crabtree is associated with the Center for Research in Family Practice and Primary Care, Cleveland, New Brunswick, Allentown, and San Antonio.