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Program shows no effect on patients' question-asking
By Amy Norton
Last Updated: 2010-03-08 17:00:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A program designed to boost doctor-patient communication and patients' compliance with treatment may not have the intended effects, a new study suggests.
The study looked at a program dubbed "Ask Me 3," which encourages patients to ask three basic questions at each doctor visit: "What is my main problem?" "What do I need to do (about the problem)?" and "Why is it important for me to do this?"
The goal is to help patients better understand any health problems they have, and make them more likely to stick with treatment or lifestyle changes.
But in the new study, patients at medical practices that promoted the "Ask Me 3" program were no more likely to ask those questions or to fill their prescriptions than patients at a group of practices used for comparison. Nor did they show a greater understanding of any recommended lifestyle changes.
However, the researchers point out that most patients at all practices in the study were good at asking questions. So it may simply have been too hard for the "AM3" program to improve upon that.
In a report in the Annals of Family Medicine, they say future studies should look at the program's effects among patients whose communication with their doctors is not so strong.
For the study, researchers led by Dr. James M. Galliher, of the American Academy of Family Physicians National Research Network, randomly assigned 20 U.S. medical practices to an intervention or a control group. Staff at the 10 practices in the intervention group gave patients pamphlets with the AM3 questions and reminded them to ask their doctor the three questions.
The researchers used audio recordings of patient visits, along with follow-up interviews, to see how effective the program was.
Overall, they found that among 829 patients across the 20 practices, there were no clear benefits from the AM3 program. Ninety-two percent of patients in both the intervention and control groups asked at least one of the three questions. And patients in both groups averaged six to seven questions of any kind per visit.
The two groups also showed little difference when it came to treatment compliance, based on interviews done within three weeks of their visit.
Of patients who said their doctor had given them a new prescription, 81 percent to 82 percent of patients in each group said they had filled it. And of those who said their doctor had recommended lifestyle changes, 91 percent to 92 percent in each group claimed to have attempted the changes.
The only clear difference was that patients in the comparison group were more likely to accurately recall that their doctor had advised lifestyle changes: 68 percent did so, versus 59 percent in the AM3 group.
According to Galliher's team, the high rates of question-asking and treatment compliance in the study group as a whole may have been too tough to improve upon. They also note that the study group had fairly strong scores on a questionnaire of "health literacy" -- a measure of, for instance, how well a person can fill out medical forms or understands written information on their health condition.
"We believe that programs like AM3 should be systematically implemented and studied across time with patients whose health literacy skills are challenged," Galliher noted in an email to Reuters Health.
"Our view is that asking questions opens the door for good patient and (doctor) communication and thus hopefully a better understanding by the patient of his/her possible health conditions and needs that can then be addressed by the patient and the (doctor)," Galliher added.
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