The Impact of Technology on Patient Perceptions of Primary Care Provider Empathy Christopher Terry, PharmD PGY1 Pharmacy Resident – Ambulatory Care Mission Hospital/MAHEC Asheville, North Carolina

Disclosure Statement None of the following individuals involved in this project have anything to disclose concerning possible financial or personal relationships with commercial entities (or their competitors) that may be referenced in this presentation. Primary investigator: Christopher Terry, PharmD Project advisors: Lori Brown, PharmD, BCACP; Rob Fields, MD; Sheri Denslow, PhD, MPH

Background EMPATHY Enhanced patient outcomes1,2 Increased patient satisfaction2 Improved patient compliance3 Less risk of malpractice litigation4 EMPATHY

Background5-8 Screen gazing in primary care: up to 25% of visit Inversely related to provider engagement in questioning, emotional responsiveness

Purpose To ascertain whether the presence and use of technology in a primary care visit impacts how patients perceive the display of provider empathy

Methodology

Objectives Primary Objective: Secondary Objective: To evaluate the impact of technology on patient’s perceptions of provider empathy in a primary care visit Secondary Objective: To examine the relationship between use of technology and patients’ perceptions of provider empathy with: Age Gender Race/ethnicity Prior technology use

Methodology Study Design: Inclusion Criteria: Exclusion Criteria: Single center, IRB-approved, prospective, single-blinded, randomized controlled trial Inclusion Criteria: Patients > 18 years of age receiving primary care services at a local physician’s office Exclusion Criteria: Patients who do not complete survey Pregnant patients Non-English speaking patients

Methodology Visit conducted w/o tech Control (n = 17) n = 34 patients in 1:1 randomization Control (n = 17) Visit conducted w/o tech MA provides survey Excluded: no demographic data (n = 3) Analyzed (n = 14) Intervention Visit conducted with tech Excluded: no demographic data (n = 5) (n = 12)

Baseline Demographics Intervention (n = 17) Control p-value Age Median (range) 60 (18-93) 51 (28-83) 0.63 Sex, no. (%) Male 6 (35.3%) 3 (17.6%) 0.55 Female 8 (47.1%) 9 (52.9%) No demographic data 5 (29.4%) Race/Ethnicity, no (%) White 13 (76.5%) 11 (64.7%) 0.56 Pacific Islander 1 (5.9%) 0 (0%) Other/refuses 5 (24.9%)

Results Intervention* Control* p-value I tend to use technology often in my daily life. 4 (2-5)† 5 (3-5) 0.54 I felt as though the technology used during my visit was both beneficial and useful. 1.00 I understood what my doctor was talking about during my appointment. 5 (4-5) 0.58 I thought the technology used was distracting and bothersome. 1 (1-4) 1 (1-5) 0.59 I would prefer to use technology at my next visit. 4 (3-5)† * = mean (range) †n = 16 patients

Results Total scores from Q6-10 24 (19-25) 25 (20-25) 0.10 Intervention* Control* p-value My doctor understood my emotions, feelings, and concerns. 5 (4-5) 0.12 My doctor seemed concerned about my family and me. 5 (3-5) 0.64 My doctor can view things from my perspective. 0.13 My doctor asks about what is happening in my daily life. 0.26 My doctor is understanding. 0.38 Total scores from Q6-10 24 (19-25) 25 (20-25) 0.10 * = mean (range)

Results

Discussion The use of technology by way of streaming electronic health records, difficult medical concepts, and/or treatment options did not result in decreased patient perception of provider empathy.

Limitations Technology as a standard of care Limited external validity Single, empathetic provider Missing demographic data Small sample size

Future Directions Evaluating empathy expressions with: Phone consults Telemedicine Video communication EMR streaming Outcomes

Self Assessment Question In what potentially negative way can technology impact the delivery of patient care? Answer: The use of technology in the primary care setting has been shown to negatively affect patient-provider relationships. This study did not show this effect in terms of patient perceptions of provider-displayed empathy.

Acknowledgements Project Advisors: Lori Brown, PharmD, BCACP Rob Fields, MD Biostatistician: Sheri Denslow, PhD, MPH

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The Impact of Technology on Patient Perceptions of Primary Care Provider Empathy Christopher Terry, PharmD PGY1 Pharmacy Resident – Ambulatory Care Mission Hospital/MAHEC Asheville, North Carolina 828.213.5537 christopher.terry@msj.org