JMIR Publications

ABSTRACT

Background:

Effective primary care necessitates actions by the patient beyond the visit. Prior research suggests there is room for improvement with patient adherence to these actions.

Objective:

We sought to understand patients’ views on their primary care visits, the plans generated in these visits, and their self-reported adherence after 3 months.

Methods:

As part of a large multi-site cluster randomized pragmatic trial in 3 healthcare organizations, patients completed 2 surveys- the first within 7 days after the index primary care visit and another 3 months later. We computed means and frequencies to describe patient characteristics and survey responses. We used cross-tabulation and chi-squared statistics to examine bivariate associations. We did qualitative content analysis to characterize the patient’s self-reported plans and reasons for adhering or not adhering to the plan 3 months later.

Results:

Of 2,555 patients, a large majority of patients selected the top box option (9 = definitely agree) that they felt they had a clear plan (78%), agreed with the plan (80%), and intended to follow the plan (83%) discussed with their provider at the primary care visit. The most common elements of the plans reported included reference to exercise (14.1%), testing (labs, imaging, etc) (12.8%), diet (11.6%) and initiation/adjustment of medication(s) (11.1%). Patients who strongly agreed that that they had a clear plan, agreed with the plan, and intended to follow the plan were all more likely to report completion of the plan 3 months later (p<0.001) compared to those providing less positive ratings. Patients who reported plans related to following up with the primary care provider (PCP), to initiate or adjust medication(s), and to have a specialist visit were more likely to report that they had completely followed the plan (p≤ 0.001). Patients’ reasons for completely following the plan were mainly that the plan was clear (69.5%), consistent with what mattered (66.1%), and they were determined to carry through with the plan (53.3%). The most common reasons for not following the plan were lack of time (22.8%), decided to try a different approach (11.0%), and the COVID pandemic impacted the plan (11.0%).

Conclusions:

Patients’ initial assessment of their plan as clear, their agreement with the plan, and their initial willingness to follow the plan were all strongly related to their self-reported completion of the plan 3 months later. Patients whose plan involved lifestyle changes were less likely to report that they had “completely” followed their plan. Clinical Trial: ClinicalTrials.gov NCT03385512