Family and Friend Participation in Primary Care Visits of Patients With Diabetes or Heart Failure

Patient and Physician Determinants and Experiences

Bibliographic Data

ID9102192
AuthorsAnn‐Marie Rosland (0000-0002-5809-5861, VA Center for Clinical Management Research, corresponding author), Ann-Marie Rosland, John D Piette (0000-0002-7241-2798, VA Center for Clinical Management Research, corresponding author), Hwajung Choi (0000-0001-6497-7679, University of Michigan), Michele Heisler (0000-0002-6889-2063, University of Michigan, corresponding author)
Year2011
Volume49
Issue1
Pages37-45
Publication date2011-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3181f37d28
PMID21102357
PMCIDPMC3712763
OpenAlexW2017763122
LanguageEN
Citations received13
References cited27

BACKGROUND: Professional and patient groups have called for increased participation of patients' informal support networks in chronic disease care, as a means to improve clinical care and self-management. Little is known about the current level of participation of family and friends in the physician visits of adults with chronic illnesses or how that participation affects the experience of patients and physicians. METHODS: Written survey of 439 functionally independent adults with diabetes or heart failure and 88 of their primary care physicians (PCPs). Patients were ineligible if they had a memory disorder, needed help with activities of daily living, or were undergoing cancer treatment. RESULTS: Nonprofessional friends or family ("companions") regularly participated in PCP visits for nearly half (48%) of patients. In multivariable models, patients with low health literacy (adjusted odds ratio [AOR]: 2.9, confidence interval [CI]: 1.4-5.7), more depressive symptoms (AOR: 1.3, CI: 1.1-1.6), and 4 or more comorbid illnesses (AOR: 3.7, CI: 1.3-10.5) were more likely to report companion participation. Patients reported that they were more likely to understand PCP advice (77%) and discuss difficult topics with the physician (44%) when companions participated in clinic visits. In multivariable models, companion participation was associated with greater patient satisfaction with their PCP (AOR: 1.7, CI: 1.1-2.7). Most PCPs perceived visit companions positively, however 66% perceived 1 or more barriers to increasing companion participation, including increased physician burden (39%), inadequate physician training (27%), and patient privacy concerns (24%). CONCLUSION: Patients' companions represent an important source of potential support for the clinical care of functionally independent patients with diabetes or heart failure, particularly for patients vulnerable to worse outcomes. Companion participation in care was associated with positive patient and physician experiences. Physician concerns about companion participation are potentially addressable through existing training resources

Confidence interval · Diabetes mellitus · Disease · Family medicine · Health care · Health literacy · Logistic regression · MEDLINE · Odds · Odds ratio · Patient participation · Patient satisfaction · Primary care · Primary care physician · Young adult · Diabetes Management and Education · Family and Patient Care in Intensive Care Units · Healthcare Systems and Technology · Internal Medicine · Medicine · Nursing · Gerontology

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