Institutional members access full text with Ovid®

Share this article on:

Family and Friend Participation in Primary Care Visits of Patients With Diabetes or Heart Failure: Patient and Physician Determinants and Experiences

Rosland, Ann-Marie MD, MS*†; Piette, John D. PhD*†; Choi, HwaJung PhD†‡; Heisler, Michele MD, MPA*†‡§

doi: 10.1097/MLR.0b013e3181f37d28
Original Article

Background: Professional and patient groups have called for increased participation of patients' informal support networks in chronic disease care, as a means to improve clinical care and self-management. Little is known about the current level of participation of family and friends in the physician visits of adults with chronic illnesses or how that participation affects the experience of patients and physicians.

Methods: Written survey of 439 functionally independent adults with diabetes or heart failure and 88 of their primary care physicians (PCPs). Patients were ineligible if they had a memory disorder, needed help with activities of daily living, or were undergoing cancer treatment.

Results: Nonprofessional friends or family (“companions”) regularly participated in PCP visits for nearly half (48%) of patients. In multivariable models, patients with low health literacy (adjusted odds ratio [AOR]: 2.9, confidence interval [CI]: 1.4–5.7), more depressive symptoms (AOR: 1.3, CI: 1.1–1.6), and 4 or more comorbid illnesses (AOR: 3.7, CI: 1.3–10.5) were more likely to report companion participation. Patients reported that they were more likely to understand PCP advice (77%) and discuss difficult topics with the physician (44%) when companions participated in clinic visits. In multivariable models, companion participation was associated with greater patient satisfaction with their PCP (AOR: 1.7, CI: 1.1–2.7). Most PCPs perceived visit companions positively, however 66% perceived 1 or more barriers to increasing companion participation, including increased physician burden (39%), inadequate physician training (27%), and patient privacy concerns (24%).

Conclusion: Patients' companions represent an important source of potential support for the clinical care of functionally independent patients with diabetes or heart failure, particularly for patients vulnerable to worse outcomes. Companion participation in care was associated with positive patient and physician experiences. Physician concerns about companion participation are potentially addressable through existing training resources.


From the *Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI; †Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; ‡University of Michigan Robert Wood Johnson Clinical Scholars Program, Ann Arbor, MI; and §Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.

Supported by the Robert Wood Johnson Clinical Scholars Program, the Michigan Diabetes Research and Training Center (NIH DK020572) and the Michigan Institute for Clinical and Health Research (NIH UL1RR024986).

John Piette is a VA HSR&D Research Career Scientist. The views expressed in this paper are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Reprints: Ann-Marie Rosland, MD, MS, VA Center for Clinical Management Research, PO Box 130170, Ann Arbor, MI 48113–0170. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2011 Lippincott Williams & Wilkins, Inc.