Benefits of Letting Patients Set Agenda Before Primary Care Visit

As more health systems aim to engage patients in their own healthcare, a new study has found that letting patients type their own agendas into their electronic medical record (EMR) before a visit improved communication between patients and physicians.

Prior research has demonstrated that collaborative agenda setting can be a useful tool for both patients and clinicians, as it lets the patient voice his or her concerns early on in the visit. However, its use in clinical practice is not always practical due to the short amount of time allotted per appointment.

A new study examined whether the same benefits could be observed when patients typed their desired agenda into their EMRs prior to their visit. Researchers invited patients in a safety-net primary clinic to test out this procedure, then asked them and their clinicians to complete surveys about the experience. Their findings were published in Annals of Family Medicine.

The 101 participants in this study generally typed short answers—4 out of 5 typed less than 60 words—but the brevity did not seem to impact effectiveness, as 79% said the agenda-setting made their visit more efficient. A large majority of patients also reported that the EMR agendas improved clinicians’ understanding of their concerns (75%), improved communication with clinicians (79%), made the clinicians more prepared (82%), and helped prioritize the visit (84%). Importantly, almost three-fourths (73%) said they would want to set the agenda again in the future.

Generally, similar levels of satisfaction were found among physicians; however, a lower percentage (63%) said the patient-written agendas made the visit more efficient. Still, support for the agenda-setting procedure as a whole was actually higher among clinicians than patients; 82% said they would want patients to type their agendas in the future.

The researchers offered some explanations for how the clinician-patient relationship seemed to improve when the agenda’s creation was placed in the hands of the patient. Allowing patients to set their agendas beforehand allows clinicians to be better prepared to focus on the patient’s needs, so that “patients and clinicians can optimize their time together.” It can also counter the perception that physicians are too focused on consulting and writing their own digital notes instead of actually connecting with the patient in front of them.

Other studies on EMR note-taking have found that patients would like the opportunity to comment on their visit notes after the appointment is over, but this research was the first that granted patients a proactive role in setting the agenda themselves. The study authors noted that further research could evaluate how agenda setting impacts patient activation and engagement.

“The patient cogeneration of visit notes, facilitated by new EMR functionality, reflects a shift in the authorship and ‘ownership’ of visit notes,” the researchers concluded. “Patient-written visit agendas could increase the collaborative nature of the clinical encounter between patient and clinician, but require further study, including measurement of patient engagement and health outcomes.”