Companions are a valuable quality of care resource that could enhance the experience for millions of vulnerable Americans
July 14, 2008 – Almost two out of every five Medicare patients age 65 or older appear for their medical visits accompanied by family members or companions, which seems to contribute to a greater satisfaction with their doctor and about everything else associated with the visit. The report in today’s Archives of Internal Medicine, one of the JAMA/Archives journals, says this is especially true among those in poor health.
Families are increasingly understood to be important to patient care, according to background information in the article. However, little is known about which specific attributes of their involvement are most helpful to patients or result in the greatest improvements in quality of care.
Jennifer L. Wolff, Ph.D., and Debra L. Roter, Dr. P.H., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues studied a sample of 12,018 Medicare beneficiaries 65 years or older who participated in a 2004 survey. These older adults were representative of approximately 30 million Medicare beneficiaries living in the community.
The researchers found that:
38.6 percent of participants reported regularly being accompanied to medical visits
Companions included spouses (53.3 percent); adult children (31.9 percent); other relatives (6.8 percent); roommates, friends or neighbors (5.2 percent); non-relatives (2.8 percent); or nurses, nurse aides or legal or financial officers (less than 1 percent)
63.8 percent of companions helped with communication, including 44.1 percent who recorded physician comments and instructions, 41.5 percent who communicated information about the patient’s medical condition to the physician, 41 percent who asked questions, 29.7 percent who explained physician’s instructions and 3.3 percent who translated the English language
28.4 percent of companions were reported to be present for company and moral support, 52.3 percent to assist with transportation, 16.6 percent to help schedule appointments and 8.4 percent to provide physical assistance
Beneficiaries with regular companions were more highly satisfied with their physician’s technical skills, information-giving and interpersonal skills.
Those whose companions more actively helped with communication rated their physicians’ information-giving and interpersonal skills more favorably.
This relationship was stronger among patients who reported themselves to be in worse health.
“Findings establish that visit companions, most often spouses and adult children, are commonly present in older adults’ routine medical encounters, actively engaged in the exchange of health information between patients and their physicians and influential in patients’ perceptions of physician interpersonal rapport and information giving,” the authors write.
“Moreover, visit companions tend to accompany patients who are especially vulnerable; in this study, accompanied patients were older, less educated and in worse health than their unaccompanied counterparts.”
“Results presented in this article suggest that patients’ visit companions, hidden, but in plain sight, are a valuable quality of care resource whose efforts, if further optimized, could enhance the experience of care for millions of vulnerable Americans,” they conclude.
Source: Jennifer L. Wolff, Ph.D., and Debra L. Roter, Dr. P.H., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore