ORIGINAL RESEARCH
Kevin Lal, MS; Clara Schneider, BS; Anna M. Espinoza, MD; Z. Noah Hendrix, MS; Richard A. Young, MD; Annesha White, PharmD, PhD; Cindy M. Lopez, MPH; Yan Xiao, PhD; Kimberly G. Fulda, DrPH
Corresponding Author: Kimberly G. Fulda, DrPH; North Texas Primary Care Practice-Based Research Network (NorTex), Department of Family Medicine and Osteopathic Manipulative Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center.
Email: Kimberly.Fulda@unthsc.edu
DOI: 10.3122/jabfm.2025.250240R1
Keywords: Aging, Communication, Health Literacy, Patient Participation, Polypharmacy, Practice-based Research, Primary Health Care
Dates: Submitted: 06-26-2025; Revised: 10-16-2025; Accepted: 10-27-2025
Status: In production.
PURPOSE: Studies have shown that facilitating patient dialogue through a structured question prompt list (QPL) during patient encounters results in greater patient engagement, improved communication and increased patient understanding. Topics most interesting to patients are unclear, thus limiting how to optimally design and use QPLs. This study identified topics most interesting to patients to discuss with their clinicians in primary care office visits.
METHODS: We collected responses to a 20-item visit guide including questions to ask, concerns to tell, and positive behaviors to report. We focused on the ask and tell sections which involved general questions and concerns patients could choose from. Participants were 50 years or older and taking five or more medications at family medicine clinics from a public safety net hospital system (240) and an urban private practice (211).
RESULTS: Of 451 visit guides collected, the selected top topics involved: 1) Diet (20.4%), 2) Taking fewer medications (15.3%), and 3) Understanding their condition (14.6%). The most common medication concerns included: 1) stopping or skipping medications due to cost, side effects, or other reasons (11.1%), 2) medications from multiple doctors (8%), and 3) specific concerns about medications (5.7%).
CONCLUSIONS: Patients reported interest in discussing questions and concerns related to diet, reducing medications, and self-care knowledge on their conditions. The questions and concerns identified in this study provide insight into the communication priorities of older adults managing multiple medications. These findings can further inform the future development of QPLs and therefore potentially reap the benefits of improved clinician-patient communication.