Klea D. Bertakis

Background: Patient-centered care (PCC) is thought to significantly influence the process of care and its outcomes and has been identified as part of a comprehensive strategy for improving our nation's healthcare delivery system. Patient and physician gender, as well as gender concordance, may influence the provision of PCC. Methods: Patients (315 women, 194 men) were randomized to care by primary care resident physicians (48 women, 57 men). Sociodemographic information, history of health risk behaviors (tobacco use, alcoholism, and obesity), and self-reported global pain and health status were collected before the first visit. That visit and subsequent patient visits to the primary care physician (PCP) were videotaped during the year-long study period. PCC was measured by coding all videotapes using a modified version of the Davis Observation Code. Results: No significant gender differences in PCC were found between the male and female patients; however, female physicians provided increased PCC to their patients. The greatest amount of PCC was seen in the female patient-female physician gender dyad. Regression analyses, controlling for other patient variables, confirmed that female concordant dyads were associated with a greater amount of PCC. There was no significant relationship for the male patient-male physician concordance (vs. disconcordance). Conclusions: These findings highlight the influence of gender in the process of care and provision of PCC. Gender concordance in female patient-female physician dyads demonstrated significantly more PCC. Further research in other clinical settings using other measures of PCC is needed. A public mandate to provide care that is patient-centered has implications for medical education.

This article uses an interactional analysis instrument to characterize patient-centered care in the primary care setting and to examine its relationship with health care utilization. Five hundred nine new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were their use of medical services and related charges monitored over 1 year. Controlling for patient sex, age, education, income, self-reported health status, and health risk behaviors (obesity, alcohol abuse, and smoking), a higher average amount of patient-centered care recorded in visits throughout the 1-year study period was related to a significantly decreased annual number of visits for specialty care (P = .0209), less frequent hospitalizations (P = .0033), and fewer laboratory and diagnostic tests (P = .0027). Total medical charges for the 1-year study were also significantly reduced (P = .0002), as were charges for specialty care clinic visits (P = .0005), for all patients who had a greater average amount of patient-centered visits during that same time period. For female patients, the regression equation predicted 15.47% of the variation in total annual medical charges compared with male patients, for whom 31.18% of the variation was explained by the average percent of patient-centered care, controlling for sociodemographic variables, health status, and health risk behaviors. Patient-centered care was associated with decreased utilization of health care services and lower total annual charges. Reduced annual medical care charges may be an important outcome of medical visits that are patient-centered.

The prediction of individuals' use of medical services and associated costs is crucial for medical systems. We modeled a risk assessment equation that included patient sociodemographic characteristics and health risk behaviors (obesity, smoking, and alcohol abuse) to strengthen the power of self-reported health status to predict healthcare resource use. We also sought to uncover gender-specific differences in the predictive value of the models. Before their first primary care visit, 509 new patients were interviewed. Data collected included sociodemographics, self-reported health status Medical Outcomes Study Short-Form (MOS SF-36), body mass index (BMI), and screening for alcoholism and smoking. Subsequent use of healthcare services for 1 year was determined by reviewing medical and billing records. Generalized linear models and two-part regressions were estimated relating the five types of charges (plus total charges) to self-reported physical health status, controlling for gender, age, education, income, obesity, smoking, alcohol abuse, and mental health status. Lower physical health status was associated with higher charges for primary care (p = 0.0022), specialty care (p = 0.0141), diagnostic services (p < 0.0001), hospitalizations (p = 0.0069), and total charges (p < 0.0001). For female patients, the regression equation predicted 14% of the variation in total medical charges compared with 28% for males. Female patients had higher charges for primary care (p = 0.0019), diagnostic services (p = 0.0005), and total charges (p = 0.0180). Health status and patient gender were significant predictors of healthcare use and charges. The R² of total charges was two times higher for men vs. women. This research has policy implications for healthcare organizations in predicting the usage patterns.

Physicians' use of patient-centered communication (PCC) affects important outcomes of care. Although there is evidence that both patient and physician gender affect the process of care, there is limited information about their impact on PCC. Our objective was to investigate the influence of patient and physician gender, as well as gender concordance between patient and physician, on the patient centeredness of primary care visits. Participating primary care physicians (100 family physicians and internists) with clinical practices in the Rochester, New York area, had two unannounced covertly audiorecorded standardized patients' visits. Encounters were analyzed using the Measure of Patient-Centered Communication (MPCC), which measures three aspects of physician communication: Component 1 (Exploring both the disease and illness experience), Component 2 (Understanding the whole person), and Component 3 (Finding common ground). Compared with male patients, females had interactions characterized by greater PCC (total and Component 2 scores). Whereas female physicians exhibited higher Component 1 scores, male physicians had higher Component 2 scores, and gender-concordant visits also exhibited higher Component 2 scores. However, there were no significant differences in total MPCC scores for encounters of female vs. male physicians or for gender-concordant compared with discordant patient-physician dyads. These findings add further evidence that patient gender can affect the interactions between physicians and patients. More research is needed to understand why male patients are less likely to have medical encounters in which their physicians employ a patient-centered practice style.

The U.S. Preventive Services Task Force recommends that clinicians screen adults for tobacco and alcohol abuse and provide appropriate interventions. This study employed direct observation and interactional analysis of medical visits to investigate factors associated with physician discussion of tobacco and alcohol use with patients. New adult patients were randomly assigned to primary care at a university medical center. Videotapes of the visits were analyzed using the Davis observation code. Regression equations related discussions of substance use (alcohol and other substances), smoking, and health promotion to patient health status, depression, age, education, income, gender, alcohol abuse, and current smoking. Patients reporting better physical health were more likely to have their physicians employ a practice style emphasizing addiction behaviors (p = .0186). Substance use (p = .0117) and health promotion counseling (p = .0130) occurred more frequently with younger patients. Physicians discussed substance use (p = < .0001) and addiction (p < .0001) more often with male patients. Problem drinkers were more likely to have physicians address their substance use (p = .0069) and focus on addiction behaviors (p = .0017). Physicians adopted an addiction-oriented practice style (p < .0001), addressing substance use (p = .0009) and smoking (p < .0001), more often with patients who smoked. Physicians appear more apt to discuss these behavioral risk factors with healthier, younger, male patients who abuse tobacco and alcohol.

Patient and physician gender may impact the process of medical care and its outcomes. Our objective was to investigate the influence of patient gender on what takes place during initial primary care visits while controlling for other variables previously demonstrated to affect the physician-patient interaction, such as physician gender and specialty, patient health status, pain, depression, obesity, age, education, and income. New patients (315 women, 194 men) were randomized for care by 105 primary care physicians. Sociodemographic information, self-reported health status and pain measures, a depression evaluation, screening for alcoholism, history of tobacco use, and measured body mass index (BMI) were collected during a previsit interview. The entire medical visit was videotaped, and then analyzed using the Davis Observation Code (DOC) system. There was no significant difference in the visit length or work intensity (number of behavioral codes) for female patients compared with male patients; however, women's visits had more discussions regarding the results of the therapeutic interventions, more preventive services, less physical examination, and fewer discussions about tobacco, alcohol, and other substance abuse. There are significant differences in the process of care between female and male patients. Physicians may be making medical decisions based on gender-related considerations. Strategies for implementing knowledge about these gender differences are crucial for the delivery of gender-sensitive care.

There is extensive evidence relating individual behavioral risk factors to adverse health outcomes and associated costs; however, more-comprehensive assessments have been limited. Our objective was to examine the relative effects of obesity, alcohol abuse, and smoking on health care use and associated charges. New adult patients (n=509) were randomly assigned to primary care physicians, and their utilization of medical services was monitored for 1 year. Variables measured included sociodemographics, self-reported health status, Beck Depression Index, measured body mass index, Michigan Alcohol Screening Test results, and smoking history. Controlling for health status, depression, age, education, income, and gender, obesity was associated with the mean number of primary care visits, diagnostic services, and primary care clinic charges. Alcohol abuse was related to the mean number of emergency department visits and diagnostic services. Smoking was associated with the mean number of specialty clinic visits and hospitalizations. Smoking also predicted charges for emergency department visits, hospitalizations, and total health care charges. The economic burden of smoking is significant, even after only 1 year. Health care providers should focus attention on smoking prevention and cessation programs as an approach for managing medical costs.