Comparison of patients' perception of provider communication with observed data

Objective: Provider-patient communication is essential to optimal oral health care. From the Direct Observation Study of Dental Practice, we compared a self-reported patient communication scale with observed data on communication behaviors.

Methods: Communication behaviors was recorded at 30-second intervals during direct observation of 2788 adult visits with dentists (DDS) and hygienists (HYG) in 120 private general dentist offices. Identified behaviors included history taking-(HT), evaluation feedback-(EF), patient questions-(PQ), preventive counseling-(PC), health promotion-(HP, defined as directing or asking for behavior change), chatting-(CH), comfort-(CF), health education-(HT) compliance-(CM, asking about current behaviors), and treatment planning-(TP). From a visit survey, patient responses to 5 questions about communication with the provider were averaged (range 1-5) and examined separately for DDS visits and HYG visits. Effects of patient characteristics and observed behavior on the patient communication scale outcome were analyzed using linear regression models, adjusted for office clustering.

Results: CH(96%) was the most frequent behavior followed by EF(79%), HT(78%), HE(64%), and PQ(58%). For DDS visits, scores (4.5±0.6) were positively affected by CH, PQ, TP, CF, better self-reported dental health and higher education(p<.05). Years as a patient attenuated the negative effect of lower education. Patient age and gender did not affect scores. For HYG scores(4.6±0.5), CH, PQ, PC, CM and female gender positively influenced communication scores, while education and years as a patient did not. HP was negatively associated with communication. Provider behaviors and patient characteristics accounted for 18.1% (DDS) and 11.5% (HYG) of model variance.

Conclusions: Patients perceive CH and PQ as communication with either provider, but other behaviors may be provider-specific. HP, defined as behavior change discussions, lowered communication scores in HYG visits. Patients with lower education and poorer oral health may need increased attention to communication by providers. Additional provider training to engage patients in dialogue regarding behavior change may be indicated. (Supported by NIDCR-1R01DE15171)