1. 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

2. 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

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

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

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

6. Methodology

7. 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

8. 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

9. 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)

10. 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%)

11. 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

12. 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)

13. Results

14. 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.

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

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

17. 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.

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

19. References
Neumann M, Bensing J, Mercer S, et al. Analyzing the "nature" and "specific effectiveness" of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Educ Couns Mar;74(3):
Neuwirth ZE. Physician empathy: should we care? Lancet Aug 30; 350(9078):606.
Hojat M, Louis DZ, Markham FW. Physicians' empathy and clinical outcomes for diabetic patients. Acad Med Mar;86(3):
Virshup BB, Oppenberg AA, Coleman MM. Strategic risk management: reducing malpractice claims through more effective patient-doctor communication. Am J Med Qual Jul-Aug;14(4):153-9.
Lown BA, Rodriguez D. Commentary: Lost in translation? How electronic health records structure communication, relationships, and meaning. Acad Med Apr;87(4): ,
Pearce C, Arnold M, Phillips C, et al. The patient and the computer in primary care consultation. J Am Med Inform Assoc Mar-Apr;18(2):
Walther, JB. Theories of computer mediated communication and interpersonal relations. In Knapp ML, Daly JA. The SAGE Handbook of Interpersonal Communication. Thousand Oaks, CA: SAGE Publications;2011:
Margalit RS, Roter D, Dunevant MA, et al. Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters. Patient Educ Couns Apr;61(1):

20. 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