Illuminating the `Black Box.'

Illuminating the `Black Box.'

Stange Kurt C; Zyzanski Stephen J; Jaén Carlos R; Callahan Edward J; Kelly Robert B; Gillanders William R; Shank Christopher J; Chao Jason; Medalie Jack H; Miller William L; Crabtree Benjamin F; Flocke Susan A; Gilchrist Valerie J; Langa Doreen M; Goodwin Meredith A

Journal of Family Practice

1998

1998-05

BACKGROUND. The content and context of family practice outpatient visits have never been fully described, leaving many aspects of family practice in a "black box," unseen by policymakers and understood only in isolation. This article describes community family practices, physicians, patients, and outpatient visits. METHODS. Practicing family physicians in northeast Ohio were invited to participate in a multimethod study of the content of primary care practice. Research nurses directly observed consecutive patient visits, and collected additional data using medical record reviews, patient and physician questionnaires, billing data, practice environment checklists, and ethnographic fieldnotes. RESULTS. Visits by 4454 patients seeing 138 physicians in 84 practices were observed. Outpatient visits to family physicians encompassed a wide variety of patients, problems, and levels of complexity. The average patient paid 4.3 visits to the practice within the past year. The mean visit duration was 10 minutes. Fifty-eight percent of visits were for acute illness, 24% for chronic illness, and 12% for well care. The most common uses of time were history-taking, planning treatment, physical examination, health education, feedback, family information, chatting, structuring the interaction, and patient questions. CONCLUSIONS. Family practice and patient visits are complex, with competing demands and opportunities to address a wide range of problems of individuals and families over time and at various stages of health and illness. Multimethod research in practice settings can identify ways to enhance the competing opportunities of family practice to improve the health of their patients. [ABSTRACT FROM AUTHOR]

PREVENTIVE health services; PRACTICE of medicine; FAMILY medicine; HOSPITAL records; MEDICAL care; PHYSICIAN-patient relations

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377–389

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