This study demonstrates that a 9-item scale to measure patient approach and views about healthcare communication with physicians has good internal consistency and validity. Two subscales were identified, approach to interactions and views about physician’s healthcare communication. To the best of our knowledge, this is the first study to examine the psychometric properties of a scale that measures both how actively patients approach encounters with healthcare providers, and how they view these interactions. Compared to patients with lower PAV-COM scores, those with higher scores more frequently obtained routine health screenings, cancer screenings, and vaccinations. These results are consistent with studies showing that patients who actively participate in medical encounters and have positive views about these interactions can influence processes of care . However, further work should investigate whether patients received more services because they asked specifically for them when they might not otherwise have been offered, or whether increased preparation for office visits led patients to follow physician recommendations.
The effect of active patient preparation for visits on the physician-patient relationship is unknown. In one study, patients who were trained to be more involved in their medical care had better health outcomes [8, 9], but they also may have experienced more anxiety and less satisfaction with their physicians than those not receiving the training . There is some debate about whether patients who actively research health information have more productive interactions with healthcare providers  or whether their research breeds skepticism and mistrust of the medical system. Nonetheless, this study suggests that patients who more actively prepare for interactions with their providers and who have more positive views about communicating with their providers receive better preventive care.
The availability of nationally representative survey data presented a promising research opportunity; nevertheless, our study shares the survey’s limitations. It is uncertain whether the PAV-COM will produce similar results if different clinical relationships are examined, since survey questions asked patients to reflect on their relationship with a specific doctor. Further psychometric testing should be performed to ensure stability of the score in different patient subgroups and to assess its relationship with patient characteristics. Additional work also should be done to assess the concurrent validity of the scale.
Sampling weights for the older adult subsample of the MCBS do not account for non-response in the questions analyzed for this study, and would need to be re-estimated. Since this would contribute to parameter uncertainty, we did not apply weights for this estimation. Given the large sample size and the efforts of Centers for Medicare and Medicaid Services’ (CMS) to collect a nationally representative sample of Medicare beneficiaries, it is unlikely that the inclusion of study-specific sampling weights would noticeably improve the generalizability of the results.
The study also has other limitations. Active patient participation in healthcare is necessary to achieve patient-centered care. This measure represents limited aspects of patient-provider communication, since it does not assess actual patient expressions of concerns or feelings, or patient sharing of “health stories” in the context of everyday life . This was a psychometric analysis of existing MCBS survey items, so some of the individual items might be construed to measure constructs other than communication. For example, the ability to call the physician’s office for advice when needed could be a measure of access to healthcare. Items such as reading about health conditions and about new medication prescriptions are generally considered to be health information seeking behaviors, rather than behaviors associated with preparing for interactions with a provider.
Preventive health measures were based on self-report, rather than on objective measures, such as medical records or claims data. Due to social desirability bias, patients who more actively sought healthcare information may have been more knowledgeable about desired preventive health behaviors and may have falsely reported fulfillment of the measures. Alternatively, these patients may have had greater awareness about whether they completed the health behaviors. However, even if the results merely reflect increased knowledge or awareness, it can be argued that patients who do not know about the recommended measures will be unable to complete them. Future research may examine the association between patient active communication and objective measures of preventive health behaviors.