PRP104: Impact of a novel intervention designed to foster connection between patients and providers in primary care: a pilot study

Juliana Baratta, MS; Donna Zulman, MD, MS; Meredith Fischer, BA, MA; Mae-Richelle Verano; Cati Brown-Johnson, PhD


Context: Presence 5 (P5) comprises five evidence-based practices associated with Quadruple Aim improvements to help clinicians engage meaningfully with patients. P5 draws on a systematic review of interpersonal interventions in healthcare, clinical observations, interviews with experts medical and non-medical experts, and review by a national panel. The P5 practices: Prepare with intention, Listen intently and completely, Agree on what matters most, Connect with the patient’s story, and Explore emotional cues. P5 practices are delivered through Presence Circles where providers discuss strategies and barriers to implementation. Objective: Pilot the P5 intervention. Study Design: Mixed-methods pre-post study with patient and provider surveys, qualitative provider interviews, and implementation evaluation. Setting: Two academic medical primary care clinics and veterans affairs (VA) General Medicine Clinic. Population studied: Patients (n = 349) of participating primary care providers (n=7). Intervention: Providers attended two Presence Circles; first circle included introduction to P5, discussion of practices, and goal-setting. Providers attended booster circles 1-2 weeks post first to discuss and check-in on goals. Visual materials throughout the clinic (posters, etc.) reinforced P5. Outcome Measures: Primary outcome on patient surveys was the CARE scale, a validated measure of patient-provider communication. Secondary outcomes included trust in provider, likelihood to recommend, and satisfaction with time spent during visit. Exploratory outcomes for providers included burnout and confidence in connecting with patients. Results: The majority of patients scored their provider as performing excellently across all CARE sub-measures (x̄pre=42.6, x̄post=42.4). Primary and secondary measures revealed a ceiling effect. Providers perceived increased presence in their patient connections and experienced professional fulfillment by developing stronger relationships. Implementation data indicates that providers found “Listen with your whole body” was the easiest to implement while “Explore emotional cues” required more practice. Providers suggested holding Presence Circles regularly to keep P5 top-of-mind. Expected Outcomes: P5 practices improve provider perceptions of patient-provider connection and wellbeing, even in settings with high patient satisfaction at baseline. Presence Circles facilitate learning and maintenance of P5 practices in the clinical setting.

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