Visit satisfaction and tailored health behavior communications in primary care



      Although studies suggest that computer-tailored health communications can help patients improve health behaviors, their effect on patient satisfaction, when used in healthcare settings, has yet to be examined.


      A stand-alone computer application was developed to provide tailored, printed feedback for patients and physicians about two of the most common adverse health behaviors seen in primary care: smoking and physical inactivity. Ten primary care providers and 150 of their patients were recruited to use the program in the office before their visit. After the visit, patients completed a self-report survey that addressed demographics, computer use history, satisfaction with the visit, and the extent to which the physician addressed the reports during the visit. All data presented were collected between October 2001 and February 2002.


      Most patients were female (67.6%), approximately half (46.0%) were seen for a routine exam, most (63.3%) had at least one chronic illness, and fewer than one third (31.3%) had ever used the Internet or e-mail. Most (81.1%) patients reported that the program was easy to use, but fewer than half of the doctors looked at the report in front of the patient (49.2%) or discussed the report with the patient (44.3%). Multivariate modeling showed that visit satisfaction was significantly greater among those whose doctor examined the report. This effect of the doctor examining the report on satisfaction was even greater for those who reported a chronic illness.


      Physicians who incorporate computer tailored messaging programs into the primary care setting, but who do not address the feedback reports that they create may contribute to patients being less satisfied with their care.
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        • Prochaska J.O
        • DiClemente C.C
        • Velicer W.F
        • Rossi J.S
        Standardized, individualized, interactive, and personalized self-help programs for smoking cessation.
        Health Psychol. 1993; 12: 399-405
        • Skinner C.S
        • Campbell M.K
        • Rimer B.K
        • Curry S.J
        • Prochaska J.O
        How effective is tailored print communication?.
        Ann Behav Med. 1999; 21: 290-298
        • Brug J
        • Steenhuis I
        • van Assema P
        • de Vries H
        The impact of a computer-tailored nutrition intervention.
        Prev Med. 1996; 25: 236-242
        • Marcus B.H
        • Bock B.C
        • Pinto B.M
        • Forsyth L.H
        • Roberts M.B
        • Traficante R.M
        Efficacy of an individualized, motivationally-tailored physical activity intervention.
        Ann Behav Med. 1998; 20: 1-8
        • Calfas K.J
        • Sallis J.F
        • Zabinski M.F
        • et al.
        Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care.
        Prev Med. 2002; 34: 153-161
      1. Lancaster T, Stead LF. Self-help interventions for smoking cessation. Cochrane Database Syst Rev 2000;2

      2. Cherry DK, Burt CW, Woodwell DA. National Ambulatory Medical Care Survey: 1999 summary, advance data from vital and health statistics. Hyattsville MD: National Center for Health Statistics, 2001

      3. Raine L. Pew Internet Project: tracking report. Washington DC: The Pew Internet & American Life Project, 2002

      4. U.S. Department of Commerce. Falling through the net. Washington DC: U.S. Department of Commerce, 2000

        • Orleans C.T
        • George L.K
        • Houpt J.L
        • Brodie K.H
        Health promotion in primary care.
        Prev Med. 1985; 14: 636-647
        • Cantor J.C
        • Baker L.C
        • Hughes R.G
        Preparedness for practice.
        JAMA. 1993; 270: 1035-1040
        • Prochaska J.J
        • Zabinski M.F
        • Calfas K.J
        • Sallis J.F
        • Patrick K
        Am J Prev Med. 2000; 19: 127-131
        • Marcus B.H
        • Simkin L.R
        The stages of exercise behavior.
        J Sports Med Phys Fitness. 1993; 33: 83-88
        • Marcus B.H
        • Rakowski W
        • Rossi J.S
        Assessing motivational readiness and decision making for exercise.
        Health Psychol. 1992; 11: 257-261
        • Marcus B.H
        • Rossi J.S
        • Selby V.C
        • Niaura R.S
        • Abrams D.B
        The stages and processes of exercise adoption and maintenance in a worksite sample.
        Health Psychol. 1992; 11: 386-395
        • Marcus B.H
        • Selby V.C
        • Niaura R.S
        • Rossi J.S
        Self-efficacy and the stages of exercise behavior change.
        Res Q Exerc Sport. 1992; 63: 60-66
        • Biener L
        • Abrams D.B
        The Contemplation Ladder.
        Health Psychol. 1991; 10: 360-365
        • Velicer W.F
        • DiClemente C.C
        • Rossi J.S
        • Prochaska J.O
        Relapse situations and self-efficacy.
        Addict Behav. 1990; 15: 271-283
        • Rohsenow D.J
        • Abrams D.B
        • Monti P.M
        • Colby S.M
        • Martin R
        • Niaura R.S
        The Smoking Effects Questionnaire for adult populations.
        Addict Behav. 2003; 28: 1257-1270
        • Comstock G.W
        • Tockman M.S
        • Helsing K.J
        • Hennesy K.M
        Standardized respiratory questionnaires.
        Am Rev Respir Dis. 1979; 119: 45-53
        • Cohen S
        • Kamarck T
        • Mermelstein R
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385-396
        • Heatherton T.F
        • Kozlowski L.T
        • Frecker R.C
        • Rickert W
        • Robinson J
        Measuring the heaviness of smoking.
        Br J Addict. 1989; 84: 791-800
      5. U.S. Department of Health and Human Services. The health consequences of smoking: cancer a report of the Surgeon General. Rockville MD: Department of Health and Human Services, 1982

      6. Fiore M, Bailey W, Cohen S, et al. Treating tobacco use and dependence. Clinical practice guideline. Washington DC: U.S. Department of Health and Human Services, Public Health Service, 2000

        • Pate R.R
        • Pratt M
        • Blair S.N
        • et al.
        Physical activity and public health.
        JAMA. 1995; 273: 402-407
        • Rubin H.R
        • Gandek B
        • Rogers W.H
        • Kosinski M
        • McHorney C.A
        • Ware Jr, J.E
        Patients' ratings of outpatient visits in different practice settings.
        JAMA. 1993; 270: 835-840
        • Oboler S.K
        • Prochazka A.V
        • Gonzales R
        • Xu S
        • Anderson R.J
        Public expectations and attitudes for annual physical examinations and testing.
        Ann Intern Med. 2002; 136: 652-659
        • Weingarten S.R
        • Stone E
        • Green A
        • et al.
        A study of patient satisfaction and adherence to preventive care practice guidelines.
        Am J Med. 1995; 99: 590-596
        • Weiss G.L
        Patient satisfaction with primary medical care.
        Med Care. 1988; 26: 383-392
        • Weisman C.S
        • Rich D.E
        • Rogers J
        • Crawford K.G
        • Grayson C.E
        • Henderson J.T
        Gender and patient satisfaction with primary care.
        J Womens Health Gend Based Med. 2000; 9: 657-665
        • Kaplan S.H
        Satisfaction surveys.
        Clin Perform Qual Health Care. 1996; 4: 216-217
        • Flocke S.A
        • Miller W.L
        • Crabtree B.F
        Relationships between physician practice style, patient satisfaction, and attributes of primary care.
        J Fam Pract. 2002; 51: 835-840