Multimorbidity and socioeconomic deprivation in primary care consultations
Multimorbidity and socioeconomic deprivation in primary care consultations
PURPOSE The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation.
METHODS We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups.
RESULTS In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727).
CONCLUSIONS In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.
127-131
Mercer, Stewart
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Zhou, Yuefang
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Humphris, Gerry M.
3b13f31e-9ae4-40a6-a067-7629aa0b7de4
McConnachie, Alex
26348495-e07b-4b09-b011-9f05ed870741
Bikker, Annemieke
8b91c778-114e-4631-8dc9-d5d3baf4f656
Higgins, Maria
948a4625-7f8c-4997-b4a4-46cf3bfcf6b3
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Fitzpatrick, Bridie
e68b9245-64be-417f-9bc0-390acbcaab48
Watt, Graham C.M.
b146c9ae-0ee8-468a-b2b5-0d122e8744e8
14 March 2018
Mercer, Stewart
e6f2116e-6556-4f7f-b894-bf8b07e8c379
Zhou, Yuefang
5c5b6a34-39b2-4bdd-bc7e-9f129df88923
Humphris, Gerry M.
3b13f31e-9ae4-40a6-a067-7629aa0b7de4
McConnachie, Alex
26348495-e07b-4b09-b011-9f05ed870741
Bikker, Annemieke
8b91c778-114e-4631-8dc9-d5d3baf4f656
Higgins, Maria
948a4625-7f8c-4997-b4a4-46cf3bfcf6b3
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Fitzpatrick, Bridie
e68b9245-64be-417f-9bc0-390acbcaab48
Watt, Graham C.M.
b146c9ae-0ee8-468a-b2b5-0d122e8744e8
Mercer, Stewart, Zhou, Yuefang, Humphris, Gerry M., McConnachie, Alex, Bikker, Annemieke, Higgins, Maria, Little, Paul, Fitzpatrick, Bridie and Watt, Graham C.M.
(2018)
Multimorbidity and socioeconomic deprivation in primary care consultations.
Annals of Family Medicine, 16 (2), .
(doi:10.1370/afm.2202).
Abstract
PURPOSE The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation.
METHODS We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups.
RESULTS In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727).
CONCLUSIONS In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.
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MM_manuscript_Finalaccepted2
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More information
Accepted/In Press date: 30 November 2017
e-pub ahead of print date: 14 March 2018
Published date: 14 March 2018
Identifiers
Local EPrints ID: 419399
URI: http://eprints.soton.ac.uk/id/eprint/419399
ISSN: 1544-1709
PURE UUID: 795bdef8-21ed-4962-b100-0fd005faa344
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Date deposited: 11 Apr 2018 16:30
Last modified: 15 Mar 2024 18:53
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Contributors
Author:
Stewart Mercer
Author:
Yuefang Zhou
Author:
Gerry M. Humphris
Author:
Alex McConnachie
Author:
Annemieke Bikker
Author:
Maria Higgins
Author:
Bridie Fitzpatrick
Author:
Graham C.M. Watt
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