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Ann Intern Med. 1993 Jul 15;119(2):129-35.

The periodic health examination provided to asymptomatic older women: an assessment using standardized patients.

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  • 1Department of Community Health Care Systems, School of Nursing, University of Washington, Seattle 98195.

Abstract

OBJECTIVES:

To describe physical examination and cancer prevention services provided by primary care physicians in response to the request for a "checkup" by an asymptomatic 55-year-old woman seeking to establish ongoing care; to assess the effects of two interventions (education and office organization) intended to improve these services; and to assess the feasibility of using "standardized" patients to evaluate physician responses to such a request.

SETTING:

Northern New England.

PARTICIPANTS:

Fifty-nine primary care physicians who were accepting new patients and were participating in a study of early detection and prevention of cancer.

DESIGN:

Cross sectional; observations of patient visits.

INTERVENTIONS:

Actresses trained to portray a specific patient role ("standardized" or "simulated" patients) visited each physician once. Physicians were blinded to the simulated patients' true identities.

MEASUREMENTS:

Actresses reported the components of the general physical examination and the cancer-related "checkup." Most interactions were audiotaped.

RESULTS:

Fourteen physical examination components were measured, ranging from assessment of vibratory sense (5%) to measurement of blood pressure (98%). Provision of 10 services recommended by the National Cancer Institute to standardized patients included 16% being advised to reduce dietary fat; 53% to do monthly breast self-examination; 74% to quit smoking; and 89% to obtain a mammogram. Physicians spent from 5 to 60 minutes with the patients. Two physicians did not charge, whereas others charged from $24 to $108. Study group assignment was not associated with statistical differences in provider performance. Two standardized patients (3%) were detected by physicians. Audiotapes were used to verify the actresses' ability to replicate their scenario (consistently repeat their performance) and to verify physician performance.

CONCLUSIONS:

Physician responses to an identical patient request varied widely in terms of time spent with the patient, the services provided, and the cost of the visit. Using standardized patients is a feasible method for assessing physician performance of the periodic health examination while controlling for case mix.

PMID:
8512162
[PubMed - indexed for MEDLINE]
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