The 130th Annual Meeting of APHA

Abstract #37230

Debra Roter, DrPH¹, Marla L. Clayman, MPH¹, Susan Larson, MS¹, and Mary Ann Cook, BSN, MA, PhD². (1) Health Policy and Management, Johns Hopkins University, 624 North Broadway, Room 750, Baltimore, MD 21205, (2) JVC Radiology and Medical Analysis LLC, 6319 Alexander Drive, Clayton, MO 63105

Objective: To determine the extent to which third parties are active in geriatric primary care visits.

Background: Third parties are present in approximately one-fourth to one half of geriatric primary care visits, yet little is known about their level of activity and influence during the visit.

Design/Methods: Videotapes of a cross-sectional sample (n=90) of accompanied non-cognitively-impaired geriatric patients with study physicians (n=29) were coded using the Roter Interaction Analysis System (RIAS). Regression analyses were conducted using generalized estimating equations (GEE) to account for the clustering of visits with the same physician.

Results: Third parties were divided into groups of minimally active (very restricted third party talk) (n=28), moderately active (third party talk similar in amount to patient talk) (n=40), or highly active (third party verbally dominant) (n=22). The average visit length of visits with minimally, moderately, and highly active third parties was 16.3, 22.0, and 18.8 minutes, respectively (F_2,87; p<.05). After controlling for the clustering effect of physician, visits with moderately active third parties had more patient psychosocial talk (c²_2,87; p<.05) and more physician biomedical information giving (c²_2,87; p<.05) than the minimally and highly active groups. Patient emotional talk was lowest in visits with highly active third parties and highest in visits with moderately active third parties (c²_2,87; p<.001).

Conclusions: While third-party involvement is common, the extent of the participation varies with consequences for patient engagement. Moderate third party involvement is predominant among this sample and appears to optimize patient engagement in the medical diologue.

Learning Objectives: At the end of the session, the participant will be able to

• Appreciate the extent to which different levels of participation of a third party affect the medical dialogue.
• Identify the utility of using Generalized Estimating Equations in research on provider-patient communication.

Keywords: Communication, Elderly

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.