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Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation

Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation
Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation
Background: most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.

Aim: to compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.

Design and setting: secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.

Method: validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.

Results: PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.

Conclusion: in deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity
0960-1643
e576-e581
Jani, Bhautesh
42157e2c-e1e1-46df-b0c0-912098475580
Bikker, Annemieke P.
4d5a91a7-0289-42eb-a344-2b8b9887233b
Higgins, Maria
ebdce5df-5aca-45b1-8290-9c97a80d2a73
Fitzpatrick, Bridie
e68b9245-64be-417f-9bc0-390acbcaab48
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Watt, Graham C.M.
b146c9ae-0ee8-468a-b2b5-0d122e8744e8
Mercer, Stewart W.
66234c9c-400d-4e2d-bf01-151d1a33b762
Jani, Bhautesh
42157e2c-e1e1-46df-b0c0-912098475580
Bikker, Annemieke P.
4d5a91a7-0289-42eb-a344-2b8b9887233b
Higgins, Maria
ebdce5df-5aca-45b1-8290-9c97a80d2a73
Fitzpatrick, Bridie
e68b9245-64be-417f-9bc0-390acbcaab48
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Watt, Graham C.M.
b146c9ae-0ee8-468a-b2b5-0d122e8744e8
Mercer, Stewart W.
66234c9c-400d-4e2d-bf01-151d1a33b762

Jani, Bhautesh, Bikker, Annemieke P., Higgins, Maria, Fitzpatrick, Bridie, Little, Paul, Watt, Graham C.M. and Mercer, Stewart W. (2012) Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation. British Journal of General Practice, 62 (601), e576-e581. (doi:10.3399/bjgp12X653633). (PMID:22867682)

Record type: Article

Abstract

Background: most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.

Aim: to compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.

Design and setting: secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.

Method: validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.

Results: PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.

Conclusion: in deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity

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Published date: August 2012
Organisations: Primary Care & Population Sciences

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Local EPrints ID: 349992
URI: http://eprints.soton.ac.uk/id/eprint/349992
ISSN: 0960-1643
PURE UUID: d6d99295-256a-429f-a434-9b49f5b46d2b

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Date deposited: 15 Mar 2013 10:21
Last modified: 08 Nov 2021 23:42

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Contributors

Author: Bhautesh Jani
Author: Annemieke P. Bikker
Author: Maria Higgins
Author: Bridie Fitzpatrick
Author: Paul Little
Author: Graham C.M. Watt
Author: Stewart W. Mercer

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