Patient exposition and provider explanation in routine interviews and hypertensive patients' blood pressure control

Abstract

Hypertensive patients' expressing themselves in their own words (Exposition) and providers' giving information (Explanation) during medical interviews were hypothesized to be associated with subsequent blood pressure control. Transcripts of routine return visits to clinics in low-income areas of Houston, TX, were coded using the Verbal Response Modes (VRM) system. VRM indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home interviews 2 weeks after the clinic visits. Patient Exposition was significantly correlated with reductions in systolic and diastolic blood pressure from clinic visit to home interview, and Provider Explanation was significantly correlated with lower diastolic blood pressure at home interview. The results suggest that patients' and providers' verbal behavior in medical interviews should be included in predictive models of blood pressure control.

PIP: Analysis of the transcriptions of 217 patients' visits to community health centers in low-income areas of Houston, Texas, for hypertension treatment suggests at least a partial correlation between patients' expressing themselves in their own words (exposition) and providers' giving information on the one hand and subsequent lowered blood pressure on the other hand. Verbal Response Mode indexes of Patient Exposition and Provider Explanation were tested in relation to systolic and diastolic blood pressure obtained during home visits 2 weeks after the medical interview. The patients' amount of talking using their own words in the medical history segment of the health center visit was significantly correlated with reductions in blood pressure from clinic to home visit, but not with blood pressure levels at the clinic or the home interview. Providers' percentage of giving objective information in the conclusion segment of the clinical interview was significantly associated with lower blood pressure at the home interview, but not with clinic levels or with change from clinic to home visit. These trends remained even after controlling for patient age, sex, ethnicity, and for provider differences. This is believed to be the 1st empirical evidence of an association between blood pressure and characteristics of the medical interview. Overall, they suggest that greater attention should be given to patient-provider verbal interaction variables in designing blood pressure control programs.