Multimorbidity and socioeconomic deprivation in primary care consultations

Mercer, S. W., Zhou, Y., Humphris, G. M., McConnachie, A., Bakhshi, A., Bikker, A., Higgins, M., Little, P., Fitzpatrick, B. and Watt, G. C.M. (2018) Multimorbidity and socioeconomic deprivation in primary care consultations. Annals of Family Medicine, 16(2), pp. 127-131. (doi:10.1370/afm.2202) (PMID:29531103)

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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.

Item Type:Articles
Keywords:Consultations, deprivation, general practice, multimorbidity, primary care.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Fitzpatrick, Dr Bridie and Higgins, Ms Maria and Mercer, Professor Stewart and Watt, Professor Graham and McConnachie, Dr Alex and Bikker, Ms Annemieke and Bakhshi, Mrs Andisheh
Authors: Mercer, S. W., Zhou, Y., Humphris, G. M., McConnachie, A., Bakhshi, A., Bikker, A., Higgins, M., Little, P., Fitzpatrick, B., and Watt, G. C.M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Annals of Family Medicine
Publisher:Annals of Family Medicine
ISSN:1544-1709
ISSN (Online):1544-1717
Copyright Holders:Copyright © 2018 Annals of Family Medicine, Inc.
First Published:First published in Annals of Family Medicine 16(2):127-131
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
388141Verbal and non-verbal communication in the consultation, patients' ratings of quality, and subsequent outcomes in general practice in areasStewart MercerChief Scientist office (CSO)CZH/4/267IHW - GENERAL PRACTICE & PRIMARY CARE