Patient-Centered Research: Influence of Obesity on Patient Satisfaction with Care

PURPOSE: In addition to adverse health effects, obese patients (pts) experience negative social and psychological consequences due to their obesity. We examined whether obesity is associated with lower pt satisfaction with care. METHODS: We surveyed and reviewed the charts of 2858 pts between the ages of 20 and 75 years (yrs) (response rate 69%, mean age 45 yrs, mean body mass index (BMI) 25.3, 74% white, 55% college graduates, and 13% with ≥3 medical diagnoses) who were cared for by primary care providers at 11 academically-affiliated practices in Boston. Information obtained by telephone survey included sociodemographic factors, health status, height, weight, and patient satisfaction with care. Summary scores (0-100) for overall satisfaction with the most recent visit and with the provider and practice generally were developed from ratings (5-point likert scale) of specific aspects of care. Diagnoses were abstracted from the medical record. We performed multivariable analyses examining the relationship between overweight (BMI 25–29.9) and obesity (BMI ≥ 30) and pt satisfaction. Analyses were adjusted for clustering by provider and relevant confounders. RESULTS: Compared with normal weight pts (BMI 19–24.9), overweight and obese pts reported lower overall satisfaction scores at their most recent visit; the scores were 85.5 for normal weight pts, 85.0 for overweight pts and 82.6 for obese pts, P = 0.05. Whereas 60% of normal weight pts rated the technical skill of their provider as excellent, only 56% of overweight and 51% of obese pts gave the same rating, P = .01. Similarly, only 51% of obese pts compared to 60% of normal weight pts gave the highest rating for whether the provider explained what was being done. After adjustment for pt age, sex, race, education, insurance type, language spoken, practice site, and whether pts saw their usual provider, obese pts still reported overall satisfaction scores 2.4 (0.4, 4.5) points lower for the most recent visit when compared to normal weight pts. When we further adjusted for self-reported health status and the number of comorbid diagnoses, obese pts reported lower scores but the difference was nonsignificant, 1.37 (0.63, 3.37). Summary scores for pt satisfaction with their usual provider and practice overall did not vary by BMI group. CONCLUSION: Obesity is associated with modest decreases in overall satisfaction scores with the most recent visit. However, these differences may be explained in part by higher illness burden in obese patients. Overall satisfaction with providers and the practice generally is not affected by patient weight

Differences in the Professional Satisfaction of General Internists in Academically Affiliated Practices in the Greater-Boston Area

Managed care has created more professional constraints for general internists. We surveyed 198 general internists at 12 academically affiliated practices in the greater-Boston area to examine professional satisfaction. Overall, these physicians were moderately satisfied (mean of 59.1 on a 100-point scale). Before adjustment, women had lower overall satisfaction than men, as well as poorer satisfaction with the domains of career concerns and patient access. Gender had no independent effect on satisfaction after adjustment for age, income, percentage of time providing direct patient care, work status, and site. Younger physicians also had lower overall satisfaction, and these differences remained after adjustment. Improvements in professional satisfaction may be required to ensure the continued recruitment of young physicians, particularly women, into general internal medicine

Clinical impact of the use of additional ultrasonography in diagnostic breast imaging.

Item does not contain fulltextThe degree of adherence with evidence-based guidelines for the use of breast ultrasonography was determined in clinical practice of radiologists in six hospitals. Additional ultrasonography was performed in 2,272 (53%) of all 4,257 patients referred for mammography. High adherence rates (mean: 95%) were observed for guidelines recommending ultrasonography in patients referred for palpable breast masses and abnormal screening and diagnostic mammograms. Lower adherence rates (mean: 81%, Pearson correlation coefficient= -0.57; p=0.001) were found for guidelines advising against additional ultrasonography in patients referred for breast symptoms, a known benign abnormality, a family history or anxiety of breast cancer. The overuse of ultrasonography in 442 patients and underuse in 95 patients led to five additional false-positive results. It was concluded that the guidelines seem workable and feasible in clinical practice and that the current daily routine of diagnostic breast imaging corresponded to a great extent to the guidelines proposed