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Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2007 Sep;99(9):1061–1065.

The association of how time is spent during outpatient visits and patient satisfaction: are there racial differences?

Sonja Harris-Haywood 1, Sarah N Sylvia-Bobiak 1, Kurt C Stange 1, Susan A Flocke 1
PMCID: PMC2575872  PMID: 17913118

Abstract

Both satisfaction with the physician and how time is spent in the patient-physician outpatient visit have been shown to differ between African-American and Caucasian patients. This study uses structural equation modeling to examine racial differences in the association between time use during the outpatient visit and patient satisfaction. This cross-sectional study employed direct observation of outpatient visits and surveys of 2,502 adult African-American and Caucasian outpatients visiting 138 primary care physicians in 84 family practices in Northeast Ohio. Patient satisfaction was measured using the Medical Outcome Study (MOS) nine-item Visit Rating Scale. Time use was assessed with the Davis Observation Code, which was used to classify every 20 seconds of a visit into 20 behavioral categories. No difference was found between African-American and Caucasian patients in the association between patient satisfaction with a physician and the time the physician spent chatting, planning treatment, providing health education, structuring the interaction, assessing health knowledge or answering patient questions. Patients were generally satisfied with their physicians, and no racial differences between Caucasians and African Americans were observed. Despite racial differences in how physicians spend time in the outpatient visit encounter, these differences are not associated with racial differences in patient satisfaction. Efforts to understand disparities in satisfaction should address areas other than how physicians allocate time in the physician-patient encounter.

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Selected References

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  1. Auslander W. F., Thompson S. J., Dreitzer D., Santiago J. V. Mothers' satisfaction with medical care: perceptions of racism, family stress, and medical outcomes in children with diabetes. Health Soc Work. 1997 Aug;22(3):190–199. doi: 10.1093/hsw/22.3.190. [DOI] [PubMed] [Google Scholar]
  2. Barr Donald A. Race/ethnicity and patient satisfaction. Using the appropriate method to test for perceived differences in care. J Gen Intern Med. 2004 Sep;19(9):937–943. doi: 10.1111/j.1525-1497.2004.30415.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bentler P. M. Comparative fit indexes in structural models. Psychol Bull. 1990 Mar;107(2):238–246. doi: 10.1037/0033-2909.107.2.238. [DOI] [PubMed] [Google Scholar]
  4. Callahan E. J., Bertakis K. D. Development and validation of the Davis Observation Code. Fam Med. 1991 Jan;23(1):19–24. [PubMed] [Google Scholar]
  5. Cook Cynthia T., Kosoko-Lasaki Omofolasade, O'Brien Richard. Satisfaction with and perceived cultural competency of healthcare providers: the minority experience. J Natl Med Assoc. 2005 Aug;97(8):1078–1087. [PMC free article] [PubMed] [Google Scholar]
  6. Cooper-Patrick L., Gallo J. J., Gonzales J. J., Vu H. T., Powe N. R., Nelson C., Ford D. E. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999 Aug 11;282(6):583–589. doi: 10.1001/jama.282.6.583. [DOI] [PubMed] [Google Scholar]
  7. Cooper Lisa A., Roter Debra L., Johnson Rachel L., Ford Daniel E., Steinwachs Donald M., Powe Neil R. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003 Dec 2;139(11):907–915. doi: 10.7326/0003-4819-139-11-200312020-00009. [DOI] [PubMed] [Google Scholar]
  8. Copeland Valire Carr, Scholle Sarah Hudson, Binko Jo Ann. Patient satisfaction: African American women's views of the patient-doctor relationship. J Health Soc Policy. 2003;17(2):35–48. doi: 10.1300/J045v17n02_02. [DOI] [PubMed] [Google Scholar]
  9. Jackson J. L., Chamberlin J., Kroenke K. Predictors of patient satisfaction. Soc Sci Med. 2001 Feb;52(4):609–620. doi: 10.1016/s0277-9536(00)00164-7. [DOI] [PubMed] [Google Scholar]
  10. Laveist Thomas A., Nuru-Jeter Amani. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002 Sep;43(3):296–306. [PubMed] [Google Scholar]
  11. Linn M. W., Linn B. S., Stein S. R. Satisfaction with ambulatory care and compliance in older patients. Med Care. 1982 Jun;20(6):606–614. doi: 10.1097/00005650-198206000-00006. [DOI] [PubMed] [Google Scholar]
  12. Oliver M. N., Goodwin M. A., Gotler R. S., Gregory P. M., Stange K. C. Time use in clinical encounters: are African-American patients treated differently? J Natl Med Assoc. 2001 Oct;93(10):380–385. [PMC free article] [PubMed] [Google Scholar]
  13. Rubin H. R., Gandek B., Rogers W. H., Kosinski M., McHorney C. A., Ware J. E., Jr Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study. JAMA. 1993 Aug 18;270(7):835–840. [PubMed] [Google Scholar]
  14. Saha Somnath, Arbelaez Jose J., Cooper Lisa A. Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health. 2003 Oct;93(10):1713–1719. doi: 10.2105/ajph.93.10.1713. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Stange K. C., Flocke S. A., Goodwin M. A. Opportunistic preventive services delivery. Are time limitations and patient satisfaction barriers? J Fam Pract. 1998 May;46(5):419–424. [PubMed] [Google Scholar]
  16. Stange K. C., Zyzanski S. J., Jaén C. R., Callahan E. J., Kelly R. B., Gillanders W. R., Shank J. C., Chao J., Medalie J. H., Miller W. L. Illuminating the 'black box'. A description of 4454 patient visits to 138 family physicians. J Fam Pract. 1998 May;46(5):377–389. [PubMed] [Google Scholar]
  17. Stange K. C., Zyzanski S. J., Smith T. F., Kelly R., Langa D. M., Flocke S. A., Jaén C. R. How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patients visits. Med Care. 1998 Jun;36(6):851–867. doi: 10.1097/00005650-199806000-00009. [DOI] [PubMed] [Google Scholar]
  18. Stewart Anita L., Nápoles-Springer Anna M. Advancing health disparities research: can we afford to ignore measurement issues? Med Care. 2003 Nov;41(11):1207–1220. doi: 10.1097/01.MLR.0000093420.27745.48. [DOI] [PubMed] [Google Scholar]
  19. Thom D. H., Stanford Trust Study Physicians Physician behaviors that predict patient trust. J Fam Pract. 2001 Apr;50(4):323–328. [PubMed] [Google Scholar]
  20. Williams R. L., Flocke S. A., Stange K. C. Race and preventive services delivery among black patients and white patients seen in primary care. Med Care. 2001 Nov;39(11):1260–1267. doi: 10.1097/00005650-200111000-00012. [DOI] [PubMed] [Google Scholar]

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