Family companions who routinely accompany older adults to physician office visits could be helpful to health care quality improvement efforts, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The authors found that three-quarters of older adults who attend physician visits with a family companion are consistently accompanied over time, nearly always by the same companion. The results are featured in the January 2012 issue of the Journal of the American Geriatrics Society.
"Continuity of care is a central tenant of an effective patient-provider partnership," said Jennifer L. Wolff, PhD, lead author of the study and an associate professor with the Bloomberg School's Department of Health Policy and Management. "Our study documents that the patient-provider relationship often includes a consistently present and actively engaged family member. This work suggests that quality of care improvements may result from more productive communication and education that targets both patients and their companions."
Wolff and her colleagues at the Johns Hopkins schools of Public Health, Nursing and Medicine, and Weill Cornell Medical College analyzed a national survey of Medicare beneficiaries ages 65 years or older. The researchers studied the influence of socio-demographic characteristics, health status and physical function in regard to consistent accompaniment to physician visits. They also examined the activities performed by older adults' family companions during medical visits.
The researchers found that 75 percent of the 9.5 million older adults who attended routine physician visits with a family companion were consistently accompanied at 12 months follow-up. Nearly 9 in 10 (87.9%) beneficiaries who were consistently accompanied over time were accompanied by the same companion. Patients who were older, less educated and diagnosed with multiple chronic conditions were more likely to be consistently accompanied at one year follow-up.
Nearly 35.5 percent of accompanied beneficiaries were physically disabled and received help with daily activities from their family companion. Companions of these patients were more active in visit communication by providing information directly to the doctor (70.5%), asking the doctor questions (67.1%) and explaining the doctor's instructions to the patient (54.5%).
"Initiatives to improve older adults' quality of chronic illness care have typically focused on improving health care professional and patient competencies, and have ignored the fact that Medicare beneficiaries often manage their health conditions and attend routine physician visits with a family member, predominantly a spouse or an adult child," said Wolff. "Results from this study may help inform health reform initiatives that seek to improve care quality and lower costs, such as the Patient Centered Medical Home."
Previous studies have shown that Medicare beneficiaries who attend routine physician visits with a family companion are disproportionately vulnerable by age, education and health, and that their Medicare expenditures are twice as high as those beneficiaries who are not accompanied by a companion.
"Going It Together: Persistence of Older Adults' Accompaniment to Physician Visits by a Family Companion" was written by Jennifer L. Wolff, PhD, Cynthia M. Boyd, MD, MPH, Laura N. Gitlin, PhD, Martha L. Bruce, PhD, MPH, and Debra L. Roter, DrPH.
This research was funded by the National Institute of Mental Health.