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Patient Educ Couns. 2011 Nov;85(2):173-9. doi: 10.1016/j.pec.2010.09.017. Epub 2010 Oct 28.

Patient-physicians' information exchange in outpatient cardiac care: time for a heart to heart?

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  • 1University of California, San Francisco Division of General Internal Medicine, UCSF Center for Vulnerable Populations, Department of Medicine, San Francisco General Hospital Medical Service, USA.



Agreement between patients and physicians is an indicator of successful communication. Concordance in domains of communication among patients with heart disease and communication barriers has not been studied.


English, Spanish, or Cantonese-speaking patients seen at a public hospital cardiology clinic were assessed with pre-visit questionnaires. Surveys of patients and their physicians immediately after the visit asked each about: (1) cardiac functional status, (2) barriers to self-management, (3) cardiac diagnoses, and (4) treatment. We assessed patient-physician concordance in these domains.


179 patients and 56 physicians completed the study. Patients had low educational attainment, limited literacy and limited English proficiency. Physicians underestimated patients' cardiac functioning status (NYHA Classes 2-4), by 1 class or more in 50% of visits. Physicians were frequently unaware of medication (38/57, 67%) and psychosocial (61/88, 69%) barriers. Patients were unable to describe even 1 matching diagnosis (72/170, 42% concordant) among 5 categories. Physicians' reported medication changes in 106/179 (59%) but patients failed to report these changes in 55% (58/106). Multivariate logistic regression analyses showed no significant association between patient characteristics and concordance.


Patients and physicians often fail to communicate effectively and determinants of concordance in CVD care require further investigation.


Developing strategies to improve communication within the medical encounter are critical to improving ambulatory chronic disease management.

Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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